Page 195 - Critical Care Notes

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■ Abdominal x-ray, CT abdomen, MRI
■ Peritoneal lavage or peritoneal aspiration and C&S studies of peritoneal
fluid or peritoneal effluent
Complications
■ Fluid and electrolyte imbalance, ↓ CVP, hypovolemia → shock → acute renal
failure
■ Intestinal obstruction from bowel adhesions
■ Peritoneal abscess
■ Sepsis
Management
■ Administer antibiotics. Obtain blood cultures to assess for sepsis.
■ Obtain peritoneal effluent cultures.
■ Provide fluid and electrolyte replacement. Administer colloids. Monitor
intake and output.
■ Use gastric or intestinal tubes to suction as indicated.
■ Administer analgesics and antiemetics. Place patient on side with knees
flexed.
■ Monitor vital signs. Assess for ↓ BP and ↑ HR. Provide cardiac monitoring.
■ Assess respiratory status. Administer O 2 or ventilator assistance as indicat-
ed by ABGs or pulse oximetry.
■ Assess abdomen for pain and distention. Auscultate bowel sounds.
■ Prepare patient for surgery as indicated to remove infected material and
correct the cause.
■ Complications include wound evisceration and abscess formation.
Crohn’s Disease
Crohn’s disease is an inflammatory bowel disease that may occur anywhere
along the GI tract. The terminal ileum and proximal large intestine are usually
involved.
Pathophysiology
Chronic inflammation → edema and thickening of intestinal mucosa → ulcers
forming in the intestines → fistulas, fissures, and abscesses → thickening of
bowel wall → narrowing of intestinal lumen → scar tissue and granulomas →
weepy edematous intestines.

GI