Peritonitis

Peritonitis is the inflammation of the peritoneum, which encompasses all the abdominal organs. Causes can be localized or systemic, including sepsis, GI or GU infections, cirrhosis with ascites, and various 'itis' conditions like appendicitis, diverticulitis, and pancreatitis. Abdominal trauma, intestinal perforation from conditions like small bowel obstruction or inflammatory bowel disorders, peritoneal dialysis, and post-operative leaks can also lead to peritonitis.

Key signs include severe abdominal pain, rebound tenderness (pain upon release of pressure), and abdominal distension. Patients will also experience fever, and potentially become 'shocky' with hypotension, tachycardia, and increased respiratory rate, indicating sepsis. Nausea and vomiting are common, and bowel sounds will be decreased as fluid accumulates in the peritoneal cavity.

Peritonitis can lead to serious complications such as hypovolemic shock due to fluid shifting out of the vascular system. Localized infections can progress to systemic sepsis. Other complications include abscess formation, paralytic ileus (bowel cessation), ARDS (Acute Respiratory Distress Syndrome), and even death if not promptly and effectively treated.

Diagnosis involves checking CBC and CMP, monitoring fluids and electrolytes, and obtaining blood cultures to detect systemic infection. Peritoneal aspiration is crucial for obtaining fluid cultures to identify the specific pathogen. Imaging techniques like X-ray, ultrasound, and CT scans help determine the extent of peritonitis, its origin, and identify complications like abscesses or paralytic ileus.

Treatment primarily involves antibiotics, specifically chosen based on culture and sensitivity results. An NG tube is inserted to rest the digestive system, requiring the patient to be NPO (nothing by mouth). Fluid and electrolyte imbalances must be carefully managed, and antiemetics are given for nausea and vomiting. Surgery may be necessary to locate and repair leaks or problem areas. Pain management is also a critical component of care.

Nursing care focuses on trending vital signs and performing thorough abdominal assessments to detect early changes. Fluid and electrolyte management, including IV fluids, is essential. Administering IV antibiotics, keeping the patient NPO, and considering TPN (Total Parenteral Nutrition) for prolonged NPO status are vital to ensure adequate nutrition and support healing, as peritonitis significantly impacts the body.