Peritonitis Treatment: What to Expect in Critical Care - Surgery

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Peritonitis is a serious medical condition characterized by inflammation of the peritoneum, the lining of the abdominal cavity. It can arise from various causes, including infections, perforation of abdominal organs, or complications from other medical conditions. Given your sister's situation, it's understandable that you are concerned, especially since she has been experiencing persistent abdominal pain, low blood pressure, and fever.


Understanding Peritonitis
Peritonitis can be classified as either primary or secondary. Primary peritonitis is usually caused by an infection in the peritoneal cavity without an obvious source, often seen in patients with liver cirrhosis or nephrotic syndrome. Secondary peritonitis, which is more common, occurs due to a perforation or rupture of an abdominal organ, such as the appendix, stomach, or intestines, leading to the spillage of contents into the peritoneal cavity.


Symptoms
The symptoms of peritonitis can include:
- Severe abdominal pain and tenderness
- Fever and chills
- Nausea and vomiting
- Loss of appetite
- Changes in bowel habits
- Low blood pressure
In your sister's case, the persistent abdominal pain and fever are concerning signs that suggest the infection may not be adequately controlled.


Treatment Approaches
The primary treatment for peritonitis typically involves:
1. Antibiotic Therapy: Broad-spectrum antibiotics are usually administered intravenously to combat the infection. The choice of antibiotics may be adjusted based on culture results and the suspected source of infection.

2. Fluid Resuscitation: Given her low blood pressure, intravenous fluids are critical to maintain blood pressure and hydration. This may include the use of vasopressors (which you referred to as "增壓計") if the blood pressure remains low despite fluid administration.

3. Surgical Intervention: In many cases of secondary peritonitis, surgical intervention is necessary to address the underlying cause, such as repairing a perforated organ or draining abscesses. If the source of infection is not resolved, antibiotics alone may not be sufficient.


Monitoring and Adjustments
Given that your sister's condition has not improved after a day of treatment, it is crucial for the medical team to reassess her situation. The decision to switch to a urological approach may indicate that the doctors suspect a urinary tract source for the infection, which could be contributing to her symptoms. This is a reasonable step, especially if there are signs of a urinary tract infection or if the abdominal pain is related to a urological issue.


What to Expect in Critical Care
In a critical care setting, patients with peritonitis are closely monitored for:
- Vital signs (heart rate, blood pressure, temperature)
- Laboratory values (white blood cell count, electrolytes, renal function)
- Response to treatment (improvement in symptoms, resolution of fever)
- Potential complications (sepsis, organ failure)
If your sister's condition does not improve, further imaging studies (like an abdominal ultrasound or CT scan) may be warranted to identify any complications, such as abscess formation or additional sources of infection.


Conclusion
It’s essential to maintain open communication with the healthcare team regarding your sister's condition and treatment plan. If you have concerns about her treatment or if her condition worsens, do not hesitate to ask the medical staff for clarification or to express your worries. They are there to provide care and support, and your sister's health is their priority. Your vigilance and concern for her well-being are important during this challenging time.