Operating Room Procedures with CC

Peritonitis is the inflammation of the peritoneal cavity. The peritoneum is a double-layered, semipermeable sac that lines the abdominal cavity and covers all the organs in the abdominal cavity. Between its visceral and its parietal layers is the peritoneal cavity. Although the peritoneum walls off areas of contamination to prevent the spread of infection, if the contamination is massive or continuous, this defense mechanism may fail, resulting in peritonitis. Perhaps the most serious complication caused by peritonitis is intestinal obstruction, which results in death in 10% of patients. Other complications include abscess formation, bacteremia, respiratory failure, and shock.

The most common cause is infection with Escherichia coli, but streptococci, staphylococci, and pneumococci may also cause the inflammation. The main sources of inflammation are the gastrointestinal (GI) tract, external environment, and bloodstream. Entry of a foreign body—such as a bullet, knife, or indwelling abdominal catheter—and contaminated peritoneal dialysate may precipitate peritonitis. Acute pancreatitis may also cause peritonitis.

Peritonitis can occur at any age and across both genders. The elderly patient with peritonitis is at greater risk for developing life-threatening complications. The young adult male population is at risk because one of the primary causes of death in this gender and age group (multiple trauma) can lead to peritonitis. There are no known racial or ethnic considerations.

HISTORY. Obtain a thorough history and try to determine the possible sources of peritoneal infection. Ascertain any history of GI disorders, penetrating or blunt trauma to the abdomen, or recent abdominal surgery. Ask if the patient has any inability to pass flatulence or stools. Ask if the patient has experienced any weakness, nausea, or vomiting or a recent history of dehydration and high temperatures.

The parietal peritoneum is well supplied with somatic nerves, whereas the visceral peritoneum is relatively insensitive. With peritonitis, stimulation of the parietal peritoneum causes sharp, localized pain, whereas stimulation of the visceral peritoneum results in a more generalized abdominal pain. The pain is a steady ache that occurs directly over the area of inflammation. The intensity depends on the type and amount of foreign substances that are irritating the

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