Pathology
The initial response to inflammation is edema, vascular congestion, bowel hypermotility, an outpouring of plasma-like fluid from the extracellular, vascular, and interstitial compartments into the peritoneal space (ascites). This is later followed by abdominal distention, which causes respiratory compromise, and hypovolemia from the fluid shift. Intestinal motility shifts from decreased to paralytic.
flowchart LR
A(Inflammation)
B(Ascites)
C(Hypovolemia)
D(Abdominal Distention)
E(Respiratory Compromise)
F(Paralytic Ileus)
A-->B
B-->C
B-->D
D-->E
C-->F
D-->F
Etiology
- Trauma, either penetrating or blunt.
- Inflammatory Conditions e.g. Inflammatory bowel diseases
- Diverticulitis, Pelvic Inflammatory Disease
- Ischemia
- Ruptured Appendix
- Perforated Peptic Ulcer
- Urinary Tract Infection
- Obstructive disorders, volvulus
- Bacterial Invasion
- Peritoneal Dialysis
Assessment Findings
- Severe abdominal pain, rebound tenderness, muscle rigidity (guarding?), abdominal distention.
- High-grade Fever (≥39°C)
- Anorexia, nausea and vomiting.
- Shallow respirations, decreased urinary output, weak, rapid pulse, fever
- Shock and associated signs:
- Tachycardia, tachypnea (both compensatory)
- Oliguria, weakness, pallor (decreased perfusion)
- Restlessness, diaphoresis
Diagnostic Examination
- WBC Count is elevated (≥20k/mm³)
- Hematocrit is elevated in cases of hemoconcentration (secondary to hypovolemia).
Nursing Intervention
- Assess for respiratory distress (due to respiratory compromise)
- Assess and monitor abdominal pain.
- Monitor for signs of septic shock.
- Maintain fluid and electrolyte balance.
- Maintain patency of nasogastric and intestinal tubes.
- Encourage deep breathing exercises.
- Utilize a Fowler’s position to localize peritoneal contents.
Medical Management
- NPO with Fluid Replacement
- Antibiotics, Analgesics
- NGT for relief of abdominal distention
- Peritoneal lavage with warm saline
- Peritoneal Drainage Tubes
- Fluid, Electrolyte, and Colloid Replacement e.g. albumin, dextran, TPN
Surgical Management
- Laparotomy: an opening is made through the abdominal wall into the peritoneal cavity as an exploratory/diagnostic procedure.
- Bowel Resection may be necessary depending on the cause.