Page 194 - Critical Care Notes

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GI
■ Hypotension, pericardial effusion, myocardial depression, heart failure,
cardiac dysrhythmias, and DIC
■ Acute renal failure, acute tubular necrosis, and azotemia
■ Hepatic dysfunction, obstructive jaundice, and paralytic ileus
■ Long-term insulin dependence and frequent exacerbations
■ Stress ulcers and esophageal varices → GI hemorrhage
■ SIRS
■ Severe hemorrhage and shock
■ Multiorgan failure, sepsis, and death
Peritonitis
Peritonitis is inflammation of the peritoneum, the serous membrane lining the
abdominal cavity and covering the viscera. It may be localized or generalized.
Peritonitis is an example of acute abdomen.
Pathophysiology
Inflammation, bacterial infection, ischemia, tumor, and trauma → leakage of
contents from the abdominal organs into the abdominal cavity → proliferation
of bacteria → tissue edema → fluid in peritoneal cavity.
Clinical Presentation
■ Abdominal pain that increases with movement such as coughing and flex-
ing the hips; rebound tenderness, guarding, and abdominal rigidity (wash-
board abdomen); Blumberg’s sign: Pressing a hand on the abdomen elicits
pain, but pain increases when releasing the hand as the peritoneum moves
back into place
■ Air and fluid in the bowel
■ Abdominal distention, hyperactive → hypoactive bowel sounds →
paralytic ileus
■ Nausea and vomiting, anorexia
■ Fever, chills and ↑ HR
■ Cloudy effluent if patient undergoing peritoneal dialysis
Diagnostic Tests
■ CBC: Assess for leukocytosis, and ↓ hemoglobin and hematocrit
■ Serum chemistries

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