Sunday, January 15, 2006

peritonitis

Peritonitis is an inflammation of the peritoneum, the serous sac lining of the abdominal cavity. The intestines normally filled with bacteria are enclosed in the peritoneum. A break in the continuity of the intestines that causes a leakage of the intestinal contents can lead to inflammation and infection of the peritoneum. Peritonitis can be caused by perforation of the appendix or a duodenal ulcer. The infection may be a generalized peritonitis or it may be localized and lead to formation of an abscess. Severe pain and tenderness usually occurs over the area of the greatest peritoneal inflammation. The location of the pain helps the physician to determine whether the peritonitis is due to a perforation of the appendix or of the duodenum. A white blood count and differential and an X-ray examination of the abdomen aid in the diagnosis.
Symptoms include severe abdominal pain and tenderness, nausea, and vomiting. The patient may be afebrile (without fever) initially but the temperature rises as the infection becomes established. The pulse becomes rapid and weak and respirations are shallow. Paralytic ileus (lack of intestinal activity) typically accompanies peritonitis with the person's abdomen becoming rigid and board-like. As the condition progresses the abdomen becomes somewhat softer and very distended with the gas and the intestinal contents that cannot pass normally through the tract. Marked leukocytosis (increase in circulating white blood cells) commonly occurs in peritonitis.
Early diagnosis of conditions such as appendicitis have decreased the incidence of peritonitis. Strict surgical asepsis and use of antibiotics before performing surgery on the intestines have further reduced the number of patients who develop peritonitis as a complication of surgery.
Preventing further leakage of intestinal contents from a duodenal ulcer into the peritoneal cavity can be achieved by surgically closing the duodenum. If intestinal contents are leaking from a ruptured appendix the appendix is removed. Gastrointestinal decompression is used to drain the accumulated gas and intestinal contents.
Replacing fluids and electrolytes is important. Water and electrolytes are lost in vomitus and drainage from the gastrointestinal intubation and the person cannot take anything by mouth. Large quantities of body fluids and electrolytes collect in the peritoneal cavity instead of circulating normally throughout the body, increasing the problems of water and electrolyte imbalance. Large doses of antibiotics are given to combat infection. Analgesics such as meperidine are often necessary to relieve pain and promote rest.
Scherer, I. C. Introductory Medical-Surgical Nursing. 3rd ed. Philadelphia: J. B. Lippincott Co., 1982.
Steinberg, F. J. Care of the Geriatric Patient, 6th ed. St. Louis: C. V. Mosby Co., 1983.

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