Peritonitis tammy McDaniel & Emily Stevens



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PERITONITIS

  • Tammy McDaniel & Emily Stevens

  • Evaluation of Athletic Injuries I

  • AH 322

  • September 29, 2003




Peritonitis (pear-ih-tuh-NYE-tis)

  • Peritonitis (pear-ih-tuh-NYE-tis)

  • Infection, or rarely some other type of

  • inflammation, of the peritoneum.

  • Peritoneum is a membrane that covers the

  • surface of both the organs that lie in the

  • abdominal cavity and the inner surface of

  • the abdominal cavity itself.



Intra-abdominal infections result in 2 major clinical manifestations

  • Early or diffuse infection results in localized or generalized peritonitis.

  • Late and localized infections produces an intra-abdominal abscess.



2 Major Types

  • Primary: Caused by the spread of an infection from the blood & lymph nodes to the peritoneum. Very rare < 1%

  • Usually occurs in people who have an accumulation of fluid in their abdomens (ascites).

  • The fluid that accumulates creates a good environment for the growth of bacteria.



Secondary: Caused by the entry of bacteria or enzymes into the peritoneum from the gastrointestinal or biliary tract.

  • Secondary: Caused by the entry of bacteria or enzymes into the peritoneum from the gastrointestinal or biliary tract.

  • This can be caused due to an ulcer eating its way through stomach wall or intestine when there is a rupture of the appendix or a ruptured diverticulum.

  • Also, it can occur due to an intestine to burst or injury to an internal organ which bleeds into the internal cavity.



Both cases are very serious & can be life threatening if not treated properly!!!



Hollow organs are more susceptible to athletic injury when they are full of waste & food products.

  • Hollow organs are more susceptible to athletic injury when they are full of waste & food products.

  • Injury to a hollow organ may so signs of:

  • > black tarry stool

  • >bright red blood in the fecal discharge

  • >bloody vomitus

  • * Always remember there may be referred pain.



Signs & Symptoms



Symptoms Con’t:

  • An acutely ill patient tends to lie “very” still because any movement causes excruciating pain.

  • They will lie with there knees bent to decrease strain on the tender peritoneum.



Exam & Evaluation

  • Feel & press the abdomen to detect any swelling & tenderness in the area as well as signs of fluid has collected in the area.

  • Listen to the bowel sounds & check for difficulty breathing, low blood pressure & signs of dehydration.



Evaluation con’t:

  • The usual sounds made by the active intestine and heard during examination with a stethoscope will be absent, because the intestine usually stops functioning.

  • The abdom may be rigid and boardlike

  • Accumulations of fluid will be notable in primary due to ascites.



Exams con’t:

  • Blood Test

  • Samples of fluid from the abdomen

  • CT Scan

  • Chest X-rays

  • Peritoneal lavage.



Treatment Approach

  • Hospitalization is common.

  • Surgery is often necessary to remove the source of infection.

  • Antibiotics are prescribed to control the infection & intravenous therapy (IV) is used to restore hydration.



TX Con’t:

  • Morphine for pain.

  • Dietary supplements (omega 3, omega 6 fatty acids, vitamin A, E, C, and zinc)



Prognosis

  • Untreated peritonitis is poor, usually resulting in death.

  • With Tx, prognosis is variable, dependent on the underlying causes.



Preventive Care

  • There is “NO WAY” to prevent peritonitis, since the diseases it accompanies are usually not under the voluntary control of an individual.

  • However, the best way to prevent serious complications is to seek medical attention as soon as symptoms appear.







References:

  • “Evaluation and Management of Secondary Peritonitis.” American Family Physician 54 (October 1996): 1724+.

  • “Subacute Bacterial Peritonitis: Diagnosis and Treatment.” American Family Physician 52 (August 1995): 645.

  • Isselbacher, Kurt J., and Alan Epstein. “Diverticular, Vascular, and Other Disorders of the Intestinal and Peritoneum.” In Harrison’s Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.



References con’t:

  • Platell C., Papadimitiriou J M., Hall J.C. The Influence of Lavage Fluid on Peritonitis. Journal of American College Surg 2000; 191: 672-680.

  • Boeschoten, EW. Long-Term Consequences of Peritonitis. Perit Dial Int. 1996;16(suppl 1): S349-S354.



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