Peritonitis and Bowel Obstruction

Question 1

xwhat is peritonitis

Answer 1

Inflammation of the peritoneum, the serous membrane lining of the abdominal cavity and covering the viscera
LIFE THREATENINGs

Question 2

pathophysiology of peritonitis

Answer 2

 Leakage of contents from abdominal organs into the abdominal cavity, inflammation, infection, ischemia, trauma, or tumor perforation
 Bacterial proliferation occurs
 Fluid in the peritoneal cavity becomes cloudy with increasing amount of protein, WBCs, cellular debris, and blood
 Intestinal tract hypermotility
 Leads to a paralytic ileus with an accumulation of air and fluid in the bowel

Question 3

risk factors of peritonitis

Answer 3

Bacterial Infection
 GI Tract
 Internal Reproductive Organs (females)
Injury or Trauma
 GSW
 Stab wound
Inflammation that extends from an organ outside of the peritoneal area
Appendicitis
Perforated Ulcer
Diverticulitis
Bowel Perforation
Abdominal Surgical Procedures
Peritoneal Dialysis

Question 4

clinical manifestations of peritonitis

Answer 4

-Initially, a diffuse type of pain is felt  Pain becomes more constant, localized, and more intense
 Movement will aggravate the pain
 Abdomen will become tender and distended with muscle rigidity
 Rebound Tenderness
 Guarding of the abdomen
 Paralytic Ileus
 Nausea/Vomiting
 Decreased peristalsis/Decreased bowel sounds
 Fever
 Tachycardia
 Tachypnea
 Dyspnea
 Hypotension

Question 5

labs and diagnostics for peritonitis

Answer 5

Elevated WBC
Decreased Hemoglobin and Hematocrit
Altered levels of potassium, sodium, and chloride
Abdominal X-Ray
 Distended bowel loops
CT Scan
 Abscess formation
 Acute inflammation or infection of an abdominal organ
 Perforated bowel
Peritoneal Aspiration
 Cultures of aspirated fluid

Question 6

Medical/nursing management of peritonitis

Answer 6

 Fluid & Electrolyte Replacement
 Analgesics
 Antiemetics
 NPO status
 NG Tube placement with suction
 Oxygen Therapy
 Antibiotic Therapy
 Surgical Options
— Drain Care
 Vital Sign Monitoring
 Intake/Output
 Continuous assessments of pain, GI function, & fluids & electrolytes
 Patient Education

Question 7

complications of peritonitis

Answer 7

Post-Operative Complications
 Wound Eviscerations
 Abscess Formation
Additional Complications
 Sepsis/Shock
 Intestinal Obstruction
— Bowel adhesions
 Pulmonary Emboli

Question 8

bowel obstruction

Answer 8

 Intestinal blockage prevents the normal flow of intestinal contents through the intestinal tract
 Obstructions can be partial or complete
 Severity of obstruction depends on region of bowel affected, whether its partially or completely
occluded, and the degree how much the blood supply to the bowel wall is being affected

Question 9

two types of bowel obstruction

Answer 9

 Small Bowel Obstruction
 Large Bowel Obstruction

Question 10

causes of small bowel obstructions

Answer 10

• Adhesions (Most Common
  Cause)
• Hernias
• Neoplasms
• Intussusception
• Volvulus
• Paralytic Ileus

Question 11

causes of large bowel obstructions

Answer 11

• Carcinoma
• Diverticulitis
• Inflammatory Bowel
  Disorders
  — Crohn’s Disease
  — Ulcerative Colitis
• Benign Tumors

Question 12

patho of a small bowel obstruction

Answer 12

Intestinal content, fluid, & gas accumulate above the obstruction  abdominal distention and retention of fluid  Increase in intestinal lumen pressure cause occlusion of capillary blood flow & compromise venous return and arterial flow Edema/necrosis/eventual rupture or perforation of
intestinal wal

Question 13

clinical manifestations of small bowel obstruction

Answer 13

 Crampy pain (wavelike)
 No BM or flatus
 Vomiting
 Peristaltic waves can assume a reverse direction with intestinal contents propelled toward the mouth (Complete Obstruction)
 Dehydration
 Distended abdomen

Question 14

diagnostics of a SBO

Answer 14

 Symptoms
 Abdominal X-Ray & CT Scan
– Findings: Abnormal quantities of gas and/or fluid in the intestines
 Lab Studies
– CBC and Electrolytes
— Reveal dehydration, loss of plasma volume, and possible infection = Dehydration occurs more quickly in patients with small bowel obstructions

Question 15

nursing management of SBO

Answer 15

Maintaining function of the NG Tube
 Assessing/measuring nasogastric output
Assess fluid & electrolyte imbalance
Antibiotic Therapy
NPO  Slow progression of diet (clear liquid then full then soft)
Analgesics
Antiemetics
 Assessing improvement:
— Return of normal bowel sounds
— Decreased abdominal distention
— Subjective improvement of abdominal pain and tenderness
— Passage of flatus or stool
Surgery
Emotional Support & Comfort
 If there are discrepancies in intake & output, worsening or pain/abdominal distention, and increased NG output, surgery will be necessary.

Question 16

what is a large bowel obstruction

Answer 16

Accumulation of intestinal contents, fluid, and gas proximal to the obstruction
Can lead to severe abdominal distention and perforation
Blood supply to colon may or may not be affected
— If blood supply to the colon is cut off, intestinal strangulation and necrosis can occur

Question 17

clinical manifestations of a LBO

Answer 17

Symptoms develop and progress slowly
 Constipation
 Bloody stools
 Abdominal distention
 Weakness
 Weight Loss
 Anorexia
 Crampy lower abdominal pain
 Fecal vomiting will develop

Question 18

diagnostics of a LBO

Answer 18

Symptoms
Abdominal X-Ray & CT Scan/MRI
 Findings: Distended colon
 Pinpoints the site of the obstruction
Barium studies are contraindicated due to risk of bowel perforation

Question 19

medical management of LBO

Answer 19

 Nasogastric Decompression
 Colonoscopy
— Performed to untwist and decompress the bowel
 Cecostomy
— Surgical opening made into the cecum that provides an outlet for releasing gas and a small amount of drainage
 Rectal Tube
— Decompress areas in the lower bowel
 Surgical Resection
— Temporary or permanent colostomy
— Ileoanal anastomosis - remove entire large bowel

Question 20

nursing management of a LBO

Answer 20

 Maintaining function of the NG Tube
 Assessing/measuring nasogastric output
 Assess fluid & electrolyte imbalance
 Antibiotic Therapy
 NPO  Slow progression of diet
 Analgesics
 Antiemetics
 Assessing improvement:
— Return of normal bowel sounds
— Decreased abdominal distention
— Subjective improvement of abdominal pain and tenderness
— Passage of flatus or stool
 Wound Care (Post-Surgery)
 Emotional Support & Comfort