Disorders of the Gastrointestinal System, 2nd Edition
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Peritonitis Peritonitis is inflammation of the peri - toneum, the membrane that lines the abdominal cavity and covers internal ab- dominal organs. Peritonitis can be acute or chronic and is typically associated with a mortality rate of less than 6%, but this varies with the type of peritonitis and oth- er conditions the patient is experiencing (Daley, 2019). Under normal conditions, the peritoneum is sterile. Peritonitis oc- curs when bacteria enter the peritoneum due to conditions such as appendicitis, di- verticulitis, abdominal abscesses, peptic ulcers, ulcerative colitis, abdominal can- cers, strangulated obstructions, or stab wounds. Chemical irritants such as gastric contents, barium, bile, and enemas can also cause peritonitis (Daley, 2019). Signs and symptoms of peritonitis in- clude the following (Daley, 2019): ● Severe and widespread abdominal pain; this pain generally intensifies and localizes in the area affected. ● Weakness. ● Hypotension. ● Tachycardia. ● Confusion. ● Fever. ● Abdominal distension and bloating. ● Diarrhea. ● Low urine output, which may indicate renal failure. In addition to patient history, the fol- lowing are used to diagnose peritonitis (Daley, 2019): ● Ultrasound : Especially helpful for assessing ascites ● Chest/abdominal x-ray : May reveal elevated diaphragm and presence of free air from a perforation but is otherwise of very limited value. ● Lab work : Blood, stool, and urine tests to assess the severity and types
of microbes present and to rule out additional causes. ● Paracentesis : Shows the presence of bacteria, blood, pus, or urine and can determine the best pharmacological treatment regimen. EVIDENCE-BASED PRACTICE Recent research has indicated that there may be a correlation between a patient’s procalcitonin level and the severity of peritonitis in combination with other markers of severity. A lev- el of 10.1 mcg/L may indicate severe peritonitis. This is used with a Mann - heim peritonitis score of >26, con- trolling nutritional status score >6 points and organ malfunction (Daley, 2019). Prevention of peritonitis is important. Gastrointestinal inflammatory conditions, as well as liver disease, especially with as- cites, should be carefully monitored, and treatment should be initiated promptly. Patients undergoing dialysis should al- ways wash their hands, use aseptic tech- nique when providing self-care to any dialysis catheters or other indwelling de- vices, keep other people and pets away from equipment, and store supplies in a clean area. Preoperative and postoper- ative antibiotic therapy (as appropriate) can help to prevent the development of peritonitis (End-Stage Renal Disease Na- tional Coordinating Center [ESRD NCC], 2020). Peritonitis is a medical emergency re- quiring immediate treatment. Antibiotic therapy tailored to an infectious organism must be initiated. Patients should remain NPO until the source and severity can be determined and fluids and electrolytes are administered intravenously. Support-
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