Ascites
Ascites an excessive accumulation of peritoneal fluid within
the peritoneal cavity. it can occur as a result to hepatic cirrhosis (portal
venous congestion), malignant disease (e.g., cancer of the testis), or
congestive heart failure. In a thin patient, as much as 1500 mL has to accumulate
before ascites can be recognized clinically. In obese individuals, a far
greater amount has to collect before it can be detected.
Peritoneal Infection
Peritoneal Infection
Infection may gain entrance to the peritoneal cavity through
several routes: from the interior of the gastrointestinal tract and
gallbladder, through the anterior abdominal wall, via the uterine tubes in
females (gonococcal peritonitis in adults and pneumococcal peritonitis in
children occur through this route), and from the blood. Collection of infected
peritoneal fluid in one of the subphrenic spaces is often accompanied by
infection of the pleural cavity. It is common to find a localized empyema in a
patient with a subphrenic abscess. It is believed that the infection spreads
from the peritoneum to the pleura via the diaphragmatic lymph vessels. A
patient with a subphrenic abscess may complain of pain over the shoulder. (This
also holds true for collections of blood under the diaphragm, which irritate
the parietal diaphragmatic peritoneum.) The skin of the shoulder is supplied by
the supraclavicular nerves (C3 and 4), which have the same segmental origin as
the phrenic nerve, which supplies the peritoneum in the center of the
undersurface of the diaphragm. To avoid the accumulation of infected fluid in
the subphrenic spaces and to delay the absorption of toxins from
intraperitoneal infections, it is common nursing practice to sit a patient up
in bed with the back at an angle of 45°. In this position, the infected peritoneal
fluid tends to gravitate downward into the pelvic cavity, where the rate of
toxin absorption is slow .
Internal
Abdominal Hernia
When a loop of
intestine enters a peritoneal pouch or recess like the lesser sac or the
duodenal recesses and becomes strangulated at the edges of the recess. Remember
that important structures form the boundaries of the entrance into the lesser
sac and that the inferior mesenteric vein often lies in the anterior wall of
the paraduodenal recess.
Peritoneal
Dialysis
Because the peritoneum is a semipermeable membrane, it allows
rapid bidirectional transfer of substances across itself. Because the surface
area of the peritoneum is enormous, this transfer property has been made use of
in patients with acute renal insufficiency. The efficiency of this method is
only a fraction of that achieved by hemodialysis.
A watery solution, the dialysate, is introduced through a catheter
through a small midline incision through the anterior abdominal wall below the
umbilicus. The technique is the same as peritoneal lavage. The products of
metabolism, such as urea, diffuse through the peritoneal lining cells from the
blood vessels into the dialysate and are removed from the patient.
