Peritonitis Treatments | Causes, Diagnosis of Peritonitis Infection

Peritonitis Treatments | Causes, Diagnosis of Peritonitis Infection .

Treatment of Peritonitis

The management of peritonitis includes both therapeutic and diagnostic efforts. While therapeutic efforts are directed to resuscitate the patient, diagnostic efforts should be continued to find out the exact cause of peritonitis.

Conservative Treatment

This in fact is the pre-operative preparation which include-

• Fluid resuscitation and correction of electrolyte imbalance
• Naso-gastric intubations for decompression
• Antibiotics and
• Ventilatory support.

Fluid resuscitation

• The patients usually have decreased volume of the body fluid with disturbed electrolytes. Large volumes of fluid may be needed very rapidly till blood volume and urine output are restored. Till the central venous pressure (CVP) reaches the level of 10cm of water, fluid administration should be at a rapid rate.
  
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• Fluid administered must include crystalloid to replace water and electrolytes. Colloids (albumin and plasma) should also be given to restore an effective volume quickly.
• Plasma protein depletion needs correction as inflamed peritoneum leaks protein continuously.
• Whole blood or packed red blood cells are administered to correct anemia and to maintain an adequate red cell mass.

Naso-gastric intubations

• Decompression is performed by nasogastric intubations to evacuate the stomach and reduce accumulation of additional air in the paralyzed bowel.
• Urinary catheterization is also important to monitor urinary output.
• Oral feeding is absolutely prohibited.
• Vital signs such as temperature, blood pressure, pulse and respiration rate are recorded every 4hrs or more if needed.
  
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• Biochemical evaluation which includes measurements of serum electrolytes, glucose, creatinine and alkaline phosphate and urinary analysis should be performed as required.

Antibiotics

Antibiotics should be administered after culture sensitivity is done.

Ventilatory support

Oxygen is administration to help the response to the increased metabolic demands of peritonitis which are so often associated with impairment of pulmonary function and mild hypoxia.

• Vaso-active drugs are administered but are not found to be of much help.
• Steroids reduce the mortality risk in suppurative (pus) peritonitis. Steroids are needed in most of the cases.
• Analgesics should be administered to patients until diagnosis is made.

Operative management

• Operation is aimed at to correct the underlying causes e.g. in appendicitis, appendicectomy should be made.
• Every attempt should be made to perform the operation as soon as possible.
• The incision is midline vertical incision.

Post-operative management

Intravenous fluids, nasogastric aspirations and antibiotics are continued. Urine output, pulse, blood pressure, temperature and blood gases are monitored frequently.