Nutrition in general patients with peritonitis

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Nutrition In general, patients with peritonitis develop some degree of gut dysfunction (eg, ileus) after exploration. Consider establishing some form of nutritional support early in the course of treatment because most patients have an insufficient enteral intake for a variable amount of time preoperatively. The existing data support that enteral nutrition is superior to parenteral hyperalimentation. If enteral feeding is contraindicated or not tolerated, parenteral nutrition should be instituted. Follow-up After resolution of peritonitis and peritoneal abscesses, follow-up care is directed mostly by specifics of the underlying disease process and the presence or absence of chronic complications (eg, enterocutaneous fistulae). Patients with simple peritoneal infections after appendicitis or cholecystitis are usually cured and do not require long-term follow-up care. Patients with peritoneal operations for perforated peptic ulcer disease, Crohn disease, pancreatitis, and others often require lifelong medical therapy and treatment of recurrent complications. Complications Surgical site infection/dehiscence The incidence of surgical site infection increases with the degree of contamination; therefore, surgical site infection occurs at much higher rates after operations for peritonitis and peritoneal abscess (ie, 5-15% compared to <5% for elective abdominal operations for noninfectious etiologies). Surgical site infection may be expected if the wound is closed in the setting of gross abdominal contamination (see Table 4). Perioperative systemic antibiotics, the use of wound protector devices, and lavage of the wound at the end of therapy do not reliably prevent this complication. These wounds should be left open and be treated with wet-to-dry dressing changes several times a day or VAC dressing should be applied. Table 4. Wound Classification and Risk for Surgical Site Infection Classification Examples Incidence of 31
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Surgical Site Infection (%) Clean Elective surgery without violation of the gut or infected spaces <2 Clean contaminated Elective bowel surgery (prepared bowel, mechanical and antibiotic) 5-15 Contaminated Emergent bowel surgery (unprepared bowel, minor spillage), drainage of infected spaces 15-30 Dirty Grossly contaminated traumatic wounds, significant intestinal spillage, grossly infected and devitalized tissue (necrotizing infection) >30 Impaired wound healing The same factors that impair clearance of the abdominal infection contribute to increased problems related to wound healing (eg, malnutrition, severe sepsis, multiple organ system dysfunction, advanced age, immunosuppression) and should be addressed aggressively. Patients with severe abdominal infections demonstrate higher incidences of fascial dehiscence and incisional hernia development, requiring later reoperation.
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  • Winter '18
  • Jane doe
  • Sula, Peritoneum, peritoneal dialysis, Peritonitis

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