Failure to Diagnose & Delay in Treatment of Acute Abdomen Due to Peritonitis (Peritoneum, Gastrointestinal, GI Inflammation)

Evaluate breaches in the standard of care in cases involving the Failure to Diagnose & Delay in Treatment of Acute Abdomen Due to Peritonitis (Peritoneum, Gastrointestinal, GI Inflammation)

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present?(Choose all that apply)
    Fever/Toxic appearance/ Shock
    Abdominal distention, pain/Vomiting/ Diarrhea
    Lassitude /Anorexia/Irritability and restlessness
    Hypotension/Tachycardia (increased heart rate)
    Shallow rapid respirations
    Rebound tenderness /Hypoactive or absent bowel sounds
    Rigidity/ Paucity of body motion
    None of the above
    Symptoms not elicited
    Answer unknown
    Why is this important?
    Clinical manifestations of primary peritonitis are characterized by fever, abdominal pain, vomiting, diarrhea and toxic appearance. Hypotension and tachycardia are common along with shallow, rapid respirations because of discomfort associated with breathing. Abdominal palpation demonstrates rebound tenderness and rigidity. Bowel sounds are hypoactive or absent.
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  • Which of the following risk factors did the patient possess?(Choose all that apply) Why is this important?
    Answer this question
    A risk factor is a variable that has a causal association with a disease or disease process; the presence of the variable in an individual or a population is associated with an increased risk of the presence or future development of the disease. Thus, risk factors may be useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.
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  • Was a medical history obtained? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's examination, enables the clinician to make educated evaluations, and be better equipped to advise the patient.
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  • Was a physical examination performed? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. It helps determine the value of incongruent and conflicting results that can emerge during the diagnostic process, and it can obviate the need for tests that are costly or expose the patient to discomfort or risk.
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  • Were the patient’s vital signs recorded? Why is this important?
    Answer this question
    Tachycardia, hypoxia, tachypnea, and hypotension are characteristic signs of peritonitis.
    (2008) 92 EMEDCN 3 599-625

  • With which of the following types of peritonitis was the patient suspected? Why is this important?
    Answer this question
    Primary Peritonitis is defined as an inflammation of the peritoneum caused by an irritant or agent, such as bacteria, fungi, viruses, talc, drugs, bile, blood, granulomas, or foreign bodies. When infection is the cause, there may be systemic manifestations of sepsis. Secondary peritonitis is defined as an inflammation or mechanical break in the gastrointestinal or genitourinary tracts or a solid organ, causing the peritoneal cavity to be exposed to the organ's flora—such as flora of the gastrointestinal tract. The peritonitis may be localized or generalized.
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  • Which of the following diagnostic investigations were performed?(Choose all that apply) Why is this important?
    Answer this question
    Supine and erect radiographs of the abdomen are the first steps in the diagnostic imaging evaluation of patients presenting with medical history and/or clinical signs suggestive of peritonitis.
    (2010) 28 ESURGO 11 568-573

  • Were antibiotics administered? Why is this important?
    Answer this question
    Antibiotic therapy must provide coverage for organisms that predominate at the site of presumed origin of the infection. For perforation of the lower GI tract, a regimen of ampicillin, gentamicin, and clindamycin will adequately address infectioncaused by several organisms.
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  • Were discharge instructions/patient education provided? Why is this important?
    Answer this question
    Patient education, medications/prescriptions, and follow-up medical care are the main components of the discharge instructions. The patient education portion should include a discussion of the patient’s medical issues and any appropriate instructions for caution and care once out of the hospital.
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  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise.
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  • Which of the following risk factors did the patient possess?(Choose all that apply) Why is this important?
    Answer this question
    A risk factor is a variable that has a causal association with a disease or disease process; the presence of the variable in an individual or a population is associated with an increased risk of the presence or future development of the disease. Thus, risk factors may be useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.
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  • To which of the following was the patient referred?(Choose all that apply) Why is this important?
    Answer this question
    Surgical consultation is required in all cases of acute peritonitis.
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  • Which of the following treatment options were not initiated after diagnosis of tertiary peritonitis? Why is this important?
    Answer this question
    The management of tertiary peritonitis should include the provision of appropriate physiologic support, the administration of antimicrobial therapy, and operation or intervention to control the source of contamination and to decrease the bacterial load.
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  • Was the patient discharged only after the peritonitis had resolved? Why is this important?
    Answer this question
    The decision to discharge a patient from the hospital depends on resolving or stabilizing the acute medical issues that the patient originally presented with.
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  • With which of the following etiologies of secondary peritonitis was the patient diagnosed? Why is this important?
    Answer this question
    Secondary peritonitis can be subdivided into three different categories dependent upon the cause of the inflammation.
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  • Which of the following diagnostic investigations were performed?(Choose all that apply) Why is this important?
    Answer this question
    Acute secondary peritonitis most often results from entry of enteric bacteria into the peritoneal cavity through a necrotic defect in the wall of the intestines or other viscus as a result of obstruction or infarction or after rupture of an intra-abdominal visceral abscess. Patients with suspected peritonitis require a complete blood count with differential , blood cultures , urinalysis with urine cultures , electrolyte studies , arterial blood gas , and C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR).
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  • Which of the following interventions were initiated after the diagnosis of acute secondary peritonitis? Why is this important?
    Answer this question
    Treatment of secondary peritonitis involves laparotomy withemergentsurgical repair of the underlying cause, fluid resuscitation, pressor medications, analgesia, and empiric antibiotic/antifungal therapy.
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  • To which of the following was the patient referred? Why is this important?
    Answer this question
    Once a diagnosis has been made, and in many cases if a diagnosis is unclear, referral to the appropriate specialists needs to be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines should be utilized.
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  • Was a pre-operative evaluation performed? Why is this important?
    Answer this question
    Unless under emergent conditions, a pre-operative basic health assessment is typically performed within 30 days of the planned surgery. At least a limited assessment is mandated by the Joint Commission on Accreditation of Healthcare Organizations on all patients, but a more thorough evaluation is necessary to obtain a comprehensive view of patient risk factors.
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