Peritoneal cavities

Ketone Administered into the peritoneal cavity LD q, mouse, mg/kg Adrninistered under the skin LD q, mouse, mg/kg... 

Poly(ethylene carbonate). Like polyesters, polycarbonates (qv) are bioabsorbable only if the hydrolyzable linkages are accessible to enzymes and/or water molecules. Thus pellets of poly(ethylene carbonate), ( OCOOCH2CH2 )n weighing 200 mg implanted ia the peritoneal cavity of rats,... 

Extravasation of barium sulfate iato the peritoneal cavity through a perforated GI tract can produce serious adverse reactions. When a perforation is suspected, the use of a water-soluble iodinated contrast medium is iadicated. In this case, oral or rectal administration of sodium or meglumine-sodium salts of diatrizoic acid (6) and oral use ofiohexol (11) are the preferred procedures. 

The relative toxicities of thallium compounds depend on their solubHities and valence states. Soluble univalent thallium compounds, eg, thaHous sulfate, acetate, and carbonate, are especiaHy toxic. They are rapidly and completely absorbed from the gastrointestinal tract, skin peritoneal cavity, and sites of subcutaneous and intramuscular injection. Tb allium is also rapidly absorbed from the mucous membranes of the respiratory tract, mouth, and lungs foHowing inhalation of soluble thallium salts. Insoluble compounds, eg, thaHous sulfide and iodide, are poorly absorbed by any route and are less toxic. 

Mice are utilized for testing antiseptics for appHcation to cuts, wounds, and incisions (339). The test bacteria, type 1 pneumococcus and hemolytic streptococcus, ate appHed to the taHs of anaesthetized mice. The tip of the taH is then dipped into the antiseptic for 2 min, after which one-half inch of the taH is removed and inserted into the peritoneal cavity and the incision is closed. If after 10 days the animals survive, the product is considered satisfactory for use as a skin antiseptic. The blood of dead animals is sampled and streaked on blood agar for confirmation of infection from the test bacteria as the cause of death. Since lack of toxicity is another requirement of a product to be appHed to wounds, this test has been combined with a toxicity test (340). 

Ascites. Patients with cirrhosis, especially fiver cirrhosis, very often develop ascites, ie, accumulation of fluid in the peritoneal cavity. This is the final event resulting from the hemodynamic disturbances in the systemic and splanchnic circulations that lead to sodium and water retention. When therapy with a low sodium diet fails, the dmg of choice for the treatment of ascites is furosemide, a high ceiling (loop) diuretic, or spironolactone, an aldosterone receptor antagonist/potassium-sparing diuretic. 

The adverse reactions associated with the menotropins include ovarian enlargement, hemoperitoneum (blood in the peritoneal cavity), abdominal discomfort, and febrile reactions. Urofollitropin administration may result in mild to moderate ovarian enlargement, abdominal discomfort, nausea, vomiting, breast tenderness, and irritation at the injection site Multiple births and birth defects have been reported with the use of both menotropins and urofollitropin. 

Intraperitoneal administration of chemotherapeutic agents has been used for many years as a way of increasing the delivery of drugs to tumors (e.g., ovarian carcinoma) located in the peritoneal cavity (Markman, 1986 Howell and Zimra, 1988). Cisplatin (Casper et al., 1983 Markman et al., 1985), cytosine arabinoside (Ara-C) (King et al., 1984 Markman et al., 1985, 1986), and bleomycin (Markman et al., 1986) are examples of intraperitoneally administered drugs which were already successfully applied in clinical settings. 

Like other high molecular weight and particulate materials such as India ink (Tsilibary and Wissig, 1977), erythrocytes (Flessner et al., 1983), latex particles (Bettendorf, 1979), or colloidal gold (Langhammer et al., 1973), liposomes are removed from the peritoneal cavity via the lymphatics of the diaphragm (Parker et al.,... 

Figure 13 presents a schematic diagram for drug absorption from the peritoneal cavity. As mentioned above, particles (e.g., erythrocytes, bacteria, colloidal gold, and liposomes) which are not able to pass capillary membranes are removed from the peritoneal cavity via the lymphatic system (Fig. 13, I and II). Relatively low molecular weight compounds (e.g., drugs) are exclusively absorbed via splenic blood capillaries into the portal vein (Fig. 13, III).

FIGURE 13 Schematic diagram for drug absorption fi om the peritoneal cavity. I and II represent the lymphatic system and III represents splenic blood capillaries. (Adapted from Hirano and Hunt, 1985.)... 

In comparison to intravenous administration of MLV, which usually results in a rapid and almost quantitative uptake into liver and spleen, the fraction taken up into these organs is lower after intraperitoneal injection of these large liposomes. The reason might be that liposomes are trapped in lymph nodes and degradation of the liposomes in the peritoneal cavity can occur (Ellens et al., 1981 Parker et al., 1982) besides, several types of liposomes are degraded more quickly in lymphatic fluid than in plasma (Parker et al, 1981a,b). 

Kim et al. (1987) showed that the prolonged retention time of Ara-C in the peritoneal cavity after intraperitoneal administration of the drug in liposomal form as discussed above resulted in better therapeutic effects on intraperitoneally inoculated L1210 cells, as compared to the free drug. The activity of intraperitoneally administered cDDP on Ehrlich ascites carcinoma in mice was increased after encapsulation in neutral liposomes (Sur et al., 1983). The in vivo studies revealed improved antitumor activity and a lower toxicity sifter administration of cDDP liposomes compared to free drug. 

Markman, M., Cleary, S., Lucas, W. E., and Howell, S. B. (1985). Intraperitoneal chemotherapy with high-dose cisplatin and cytosine arabinoside for refractory ovarian carcinoma and other malignancies principally involving the peritoneal cavity, J. Clin. Oncol., 3, 925-931. 

Markman, M. (1986). Intraperitoneal antineoplastic agents for tumors principally confined to the peritoneal cavity. Cancer Treatm. Rev., 1, 219-242. 

Tsilibary, E. C., and Wissig, S. L. (1977). Absorption from the peritoneal cavity SEM study of the mesothelium covering the peritoneal surface of the muscular portion of the diaphragm, Am. J. Anat.. 149. 127-133. 

Immunological tests indicated that fraction 1, obtaned by gel chromatography had an immunostimulating activity. It induced migration of peritoneal-exudative cells, respectively peritoneal macrophages into the peritoneal cavity of experimental animals. These cells are with high bactericidic metabolitic activity. 

Peritoneal dialysis (PD) utilizes similar principles as hemodialysis in that blood is exposed to a semipermeable membrane against which a physiologic solution is placed. In the case of PD, however, the semipermeable membrane is the peritoneal membrane, and a sterile dialysate is instilled into the peritoneal cavity. The peritoneal membrane is composed of a continuous single layer of mesothelial cells that covers the abdominal and pelvic walls on one side of the peritoneal cavity, and the visceral organs, including the GI tract, liver, spleen, and diaphragm on the other side. The mesothelial cells are covered by microvilli that increase the surface area of the peritoneal membrane to approximate body surface area (1 to 2 m2). 

In PD, prewarmed dialysate is instilled into the peritoneal cavity where it dwells for a specified length of time (usually one to several hours, depending on the type of PD) to adequately clear metabolic waste products. At the end of the dwell time, the dialysate is drained and replaced with fresh dialysate. The continuous nature of PD provides for a more physiologic removal of waste products from the bloodstream, which mimics endogenous renal function by decreasing the fluctuations seen in serum concentrations of the waste products. Similarly, water is removed at a more constant rate, lessening the fluctuations in intravascular fluid balance and providing for more hemodynamic stability. 

Access to the peritoneal cavity requires placement of an indwelling catheter. There are several types of indwelling catheters available, but all require placement of the distal end into the peritoneal cavity. The central portion of the catheter... 

The preferred route of administration is intraperitoneal (IP) rather than IV to achieve maximum concentrations at the site of infection. Antibiotics can be administered IP intermittently as a single large dose in one exchange per day or continuously as multiple smaller doses with each exchange. Intermittent administration requires at least 6 hours of dwell time in the peritoneal cavity to allow for adequate systemic absorption and provides adequate levels to cover the 24-hour period. However, continuous administration is better suited for PD modalities that require more frequent exchanges (less than 6-hour dwell time). The reader should refer to the ISPD guidelines for dosing recommendations for IP antibiotics in CAPD and automated PD patients.49 The dose of the antibiotics should be increased by 25% for patients with residual renal function who are able to produce more than 100 mL urine output per day. 

Peritonitis may be classified as primary, secondary, or tertiary. Primary peritonitis, also called spontaneous bacterial peritonitis, is an infection of the peritoneal cavity without an evident source of bacteria from the abdomen.1,2 In secondary peritonitis, a focal disease process is evident within the abdomen. Secondary peritonitis may involve perforation of the gastrointestinal (GI) tract (possibly because of ulceration, ischemia, or obstruction), postoperative peritonitis, or posttraumatic peritonitis (e.g., blunt or penetrating trauma). Tertiary peritonitis occurs in critically ill patients and is infection that persists or recurs at least 48 hours after apparently adequate management of primary or secondary peritonitis. 

The fluid and protein shift into the abdomen (called third-spacing) may be so dramatic that circulating blood volume is decreased, which causes decreased cardiac output and hypovolemic shock. Accompanying fever, vomiting, or diarrhea may worsen the fluid imbalance. A reflex sympathetic response, manifested by sweating, tachycardia, and vasoconstriction, may be evident. With an inflamed peritoneum, bacteria and endotoxins are absorbed easily into the bloodstream (translocation), and this may result in septic shock. Other foreign substances present in the peritoneal cavity potentiate peritonitis, notably feces, dead tissues, barium, mucus, bile, and blood. 

DPL (Diagnostic Peritoneal Lavage Examination of Fluid in Peritoneal Cavity) No blood is found, but WBCs are evident. 

In patients with peritonitis, hypovolemia is often accompanied by acidosis, so large volumes of a solution such as lac-tated Ringers may be required initially to restore intravascular volume. Maintenance fluids should be instituted (after intravascular volume is restored) with 0.9% sodium chloride and potassium chloride (20 mEq/L) or 5% dextrose and 0.45% sodium chloride with potassium chloride (20 mEq/L). The administration rate should be based on estimated daily fluid loss through urine and nasogastric suction, including 0.5 to 1.0 L for insensible fluid loss. Potassium would not be included routinely if the patient is hyperkalemic or has renal insufficiency. Aggressive fluid therapy often must be continued in the postoperative period because fluid will continue to sequester in the peritoneal cavity, bowel wall, and lumen. 

Ascites Abnormal accumulation of serous fluid in the spaces between tissues and organs in the peritoneal cavity of the abdomen. 

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