PERITONITIS
SET BY: TALEMA WORKINEH
OUTLINES
• Introduction to peritonitis
• Types of the peritonitis
• Causes of the peritonitis
• Pathophysiology of the peritonitis
• Clinical manifestations
OUTLINES…
• Complications of the peritonitis
• Diagnostic studies
• Management of the peritonitis
• Nursing care plan
• Reference
INTRODUCTION TO PERITONITIS
Definition : Peritonitis is an
inflammation (irritation) of the
peritoneum, the thin tissue that lines
the inner wall of the abdomen and
covers most of the abdominal
organs.
Peritonitis: Results from a localized
or generalized inflammatory process
of the peritoneum.
Types
1. Primary peritonitis
Occurs when blood-borne organisms enter the
peritoneal cavity.
For example, the ascites that occurs with
cirrhosis of the liver provides an excellent liquid
environment for bacteria to flourish(infection).
2. Secondary peritonitis
Is much more common.
It occurs when abdominal organs perforate or
rupture and release their contents (bile,
enzymes, and bacteria) into the peritoneal
cavity(perforation).
Causes
o A ruptured appendix
o Perforated gastric or duodenal ulcer
o Severely inflamed gallbladder
o Trauma from gunshot or knife
wounds
o Peritoneal dialysis
o Pancreatitis
Pathophysiology
Etiological factors-Intestinal contents
and bacteria irritate the normal
sterile peritoneum Produce an
immediate chemical peritonitis
that is followed a few hours later by a
bacterial
peritonitisInflammatory
response massive fluid
shifts(peritoneal edema)
severe infection through out the
body Death in severe cases
Clinical Manifestations
Abdominal pain is the most common
symptom of peritonitis.
Universal sign of peritonitis is tenderness
over the involved area.
Rebound tenderness, muscular rigidity,
and spasm are other major signs of
irritation of the peritoneum.
Patients may take only shallow respirations
because movement causes pain.
Clinical…
Abdominal distention or ascites
Fever
Tachycardia
Tachypnea
Nausea
Vomiting
Altered bowel habits -Passing few or no
stools or gas, Passing less urine
Complications
Hypovolemic shock
Sepsis
Intraabdominal abscess formation
Paralytic ileus
Acute respiratory distress syndrome
Multiorgan dysfunction syndrome
Adhesional small bowel obstruction
Peritonitis can be fatal if treatment is
delayed.
Diagnostic Studies
• A CBC is done to determine elevations in WBC
count and hemoconcentration from fluid shifts.
• Peritoneal aspiration may be performed and
the fluid analyzed for blood, bile, pus, bacteria,
fungus, and amylase content(Abdominal
paracentesis and culture of fluid).
• An x-ray of the abdomen: free air if
perforation has occurred, or air and fluid
levels if an obstruction is present.
Diagnostic…
• Ultrasound and CT scans may be useful in
identifying the presence of ascites and
abscesses.
• Peritoneoscopy (placement of an endoscope
through a stab wound in the abdomen to
inspect the peritoneum) may be helpful in the
patient without ascites.
• Direct examination of the peritoneum can
be obtained, along with biopsy specimens for
diagnosis.
MANAGEMENT
Surgery
Appropriate antibiotics are given
to treat the infection :Ampicillin
NG suction
Analgesics
IV fluid administration
Preoperative Care
NPO status
IV fluid replacement
Antibiotic therapy
NG suction
Analgesics (e.g., morphine)
Oxygen
Preparation for surgery
Postoperative Care
NPO status
NG tube to low-intermittent suction
Semi-Fowler's position
IV fluids with electrolyte replacement
Parenteral nutrition as needed
Antibiotic therapy
Blood transfusions as needed
Sedatives and opioids
Nursing Assessment
• Assessment of the patient's pain,
including the location, is important and
may help in determining the cause of
peritonitis.
• The patient should be assessed for the
presence and quality of bowel sounds,
increasing abdominal distention, nausea,
fever, and manifestations of hypovolemic
shock.
Nursing Diagnoses
Acute pain related to inflammation of the
peritoneum and abdominal distention.
Risk for deficient fluid volume related to fluid
shifts into the peritoneal cavity secondary to
trauma, infection, or ischemia.
Imbalanced nutrition less than body
requirements related to anorexia, nausea, and
vomiting
Anxiety related to uncertainty of cause or
outcome of condition and pain.
Nursing Intervention with Rationale
1. Monitor vital signs, noting presence of
hypotension (including postural changes),
tachycardia, tachypnea, and fever.
Rationale: Aids in evaluating degree of fluid
deficit, effectiveness of fluid replacement
therapy, and response to medications.
Nursing…
2. Observe skin and mucous
membrane dryness and turgor. Note
peripheral and sacral edema.
Rationale: Hypovolemia, fluid shifts,
and nutritional deficits contribute to
poor skin turgor and taut edematous
tissues
Nursing…
3, Change position frequently, provide frequent
skin care, and maintain dry, wrinkle-free
bedding.
Rationale: Edematous tissue with
compromised circulation is prone to
breakdown.
4. Maintain NPO status with NG or
intestinal aspiration.
Rationale: Reduces vomiting caused by
hyperactivity of bowel; manages stomach and
intestinal fluids.
Nursing…
5.Measure urine specific gravity.
Rationale: Reflects hydration status and changes
in renal function, which may warn of
developing acute renal failure in response to
hypovolemia and effect of toxins.
Note: Many antibiotics also have nephrotoxic
effects that may further affect kidney function
and urine output.
Reference
1. Text Book of Medical- surgical Nursing vol 2,
13th edition
2. Baley and Love’s Short Practice of Surgery,
26th edition
3. Google Chrome
THANKS!
