Peritonitis

Question 1

Peritonitis?

Answer 1

Inflammation of the peritoneal membrane

Question 2

Etiology of peritonitis?

Answer 2

• Bacteria (esp. E coli)
• Chemicals (eg. bile, gastric acid entering the body cavity)
• Pelvic Inflammatory disease
• Iatrogenic (colonoscopy/endoscopy perforates the bowel tissue)

Question 3

Pelvic Inflammatory Disease?

Answer 3

occurs in women when bacteria migrate up the reproductive tract and into the Fallopian tubes, move out the infundibulum and into the body cavity

Question 4

What are 2 disadvantages of the peritoneum being a large structure?

Answer 4

1. It is richly vascularized so bacteria can get into the bloodstream and spread very easily.
2. Toxins produced by bacteria are rapidly absorbed

Question 5

Patho behind peritonitis.

Answer 5

Initially, an agent (eg. bacteria) impacts the peritoneum, and then inflammation is triggered. With inflammation comes the production of purulent exudate that is THICK, STICKY, and FIBRINOUS. The nervous system brings about ileus.

Question 6

What are 2 advantages of purulent exudate in peritonitis?

Answer 6

1. It seals or plugs the perforation so that less or no content leaks out of the hole of the gut.
2. it contains fluid, proteins, defense cells, and bacteria. Because it as a thick consistency, it will spread throughout the body cavity more slowly, limiting the spread of the agent/bacteria and localizing the inflammation.

Question 7

Ileus?

Answer 7

Cessation of peristalsis

Question 8

The nervous system brings about ileus. What kind of mechanism is this?

Answer 8

Compensatory mechanism by the sympathetic nervous system that limits GI motility and reduces the spread of bowel content through the perforation in the gut.

Question 9

Manifestations of peritonitis?

Answer 9

• severe
• fluid shift into the bowel and abdominal cavity
• with inflammation, there is vasodilation and hyperemia
• perfusion is altered and blood is shunted (moved from one place to another) to the site of inflammation
• pain
• vomiting
• dyspnea

Question 10

What does inflammation result in (in peritonitis)?

Answer 10

There is vasodilation and hyperemia, so CHP in the abundant vessels of the peritoneum is increased. This results in fluid moving out into the body cavity, which can result in ascites.

Question 11

Why does dyspnea occur in peritonitis?

Answer 11

Breathing irritates the inflamed peritoneum when the diaphragm pushes on it, so the pt will minimize their depth of respirations.

Question 12

Treatment options for peritonitis.

Answer 12

• Patient will be NPO
• IV antibiotics
• NG suction
• Fluid and electrolyte balance closely monitored
• anti-inflammatories
• analgesics
• surgery if indicated

Question 13

Why will a patient be NPO?

Answer 13

1. they will likely require surgery

2. food will initiate peristalsis, which will push more gut content out

Question 14

Why is an NG suction used for treatment?

Answer 14

To ensure nothing is in the gut