Peritonitis - Causes, symptoms and treatment. MF.
Jul 03, 2018
Peritonitis is an inflammation of the peritoneum, which is accompanied by poisoning of the body and a concomitant disruption of the work of many organs and systems. The peritoneum - a thin sheet of connective tissue that covers the abdominal cavity from the inside, restricting it from the muscles and internal organs, separating them from each other. Peritoneum has a remarkable property - when exposed to pathogenic microorganisms, it begins to produce substances that cause their death. In the case when the number of microbes exceeds the protective properties of the peritoneum, it itself becomes a source of the disease and develops peritonitis. Peritonitis refers to life-threatening conditions, and when untimely treatment for medical care, the prognosis is usually unfavorable.
peritonitis leading role in the occurrence of peritonitis plays a massive entry of germs into the abdominal cavity. As a rule, this occurs when the wall of the abdominal cavity is ruptured due to a disease or trauma. Less often, peritonitis develops with the introduction of an infection with blood or lymph flow.
most often peritonitis complicated disorders such as appendicitis, perforated gastric ulcer or duodenal ulcer, ileus, necrosis of the intestine portion hernia, organ destruction by decay tumor and abdominal trauma injuries or organ rupture, damage to the stomach wall or bowelforeign body.
Sometimes peritonitis occurs when the blood enters the abdominal cavity, for example, when the vessel is ruptured. Such peritonitis is called non-microbial or aseptic. But, as a rule, after 4-6 hours in the area of the hematoma from the intestine penetrate the pathogenic bacteria, and peritonitis becomes bacterial.
also to the development of peritonitis can cause suppuration large amounts of fluid( ascites), which accumulates in the peritoneal cavity in diseases such as renal or cardiac insufficiency.
symptoms of peritonitis
external manifestations depend on the symptoms of the disease that is the cause of peritonitis, and can vary greatly. But all the same, depending on the time that has passed since the onset of inflammation, several stages of peritonitis are conventionally isolated.
The first stage - reactive - the first day of the disease. Characterized by pronounced local manifestations. As a rule, the pain arises suddenly, in a clearly defined area. The appearance and nature of pain is sometimes compared to sensations when a dagger strikes. At this time, the epicenter of pain is usually determined in the region of the affected organ, for example, when the appendix is ruptured - in the right lower-side zone, perforation of the stomach ulcer - the left hypochondrium and / or in the epigastric region. The pain is very intense, with a tendency to spread. Often pain is permanent, but sometimes there is a symptom of imaginary well-being. At the same time, the pain becomes less intense, the patient calms down. After 2-3 hours, the pain appears again.
The appearance of the patient is characteristic - the skin is pale, sometimes gray-earthy or cyanotic in color, covered with a cold sweat, the expression of suffering on the face. The patient tries in every possible way to alleviate suffering - takes a forced position on his back or on his side with the legs brought to his stomach, tries not to inflate his belly while breathing, restrain cough.
Forced position in peritonitis
Muscle tension is so pronounced that talk about wooden belly. As a rule, feeling the stomach causes significant pain. When peritonitis pain increases with a rapid withdrawal of the hand after pressing on the stomach. This symptom is so typical that it was isolated in a separate symptom - a symptom of Shchetkin-Blumberg.
The patient may experience repeated vomiting, which does not bring relief, false urge to urinate, defecate. Already at this stage, symptoms of poisoning of the body are manifested, such as an increase in body temperature to 38 degrees, chills, frequent weak pulse, dry tongue, cheeks, expressed thirst.
The second stage of peritonitis - toxic - is characterized by a more severe general condition with marked symptoms of poisoning the body. It develops 24-72 hours after the onset of the disease. In this case, local manifestations, such as abdominal pain, muscle tension of the anterior abdominal wall, are weak or nonexistent. The features of the face are sharpened against the background of pronounced pallor of the lips, the tip of the nose, ear lobes, nails become cyanotic. Hands and feet are cold to the touch. Developed a violation of consciousness( a strong excitement, or more often, complete indifference).Periodically complete loss of consciousness. The patient lies motionless on his back, feeling the stomach does not cause any sensations. Difficulty of dry mouth and thirst. Continued painful vomiting, not bringing relief. Vomit dark brown, with an unpleasant odor. Sharply reduced the amount of urine until her absence. The body temperature is up to 40-42 degrees, breathing is intermittent, the pulse is frequent, hardly palpable.
The third stage is irreversible or terminal. Develops after 3 days from the onset of the disease and, unfortunately, in 2-3 days ends with death. The general condition is extremely difficult. At this stage, the outward manifestations are so characteristic and similar in all cases that they were combined under the name "Hippocrates face": moist pale cyanotic skin, sunken cheeks, pointed facial features. When feeling, the tension of the abdominal muscles is absent, there are no pain sensations. Absence or abrupt disruption of breathing, blood pressure and pulse are not determined. As a rule, at this time patients are in intensive care units in conditions of artificial life support.
Diagnosis of peritonitis
Diagnosis of peritonitis is based on the identification of external signs, symptoms specific to the disease that caused peritonitis, as well as laboratory and instrumental methods of investigation. In the blood test, signs of inflammation are detected - an increase in leukocytes, a decrease in the level of erythrocytes and hemoglobin, at later stages - a violation of the coagulation system. When ultrasound is diagnosed, the pathology of the organ that is complicated by peritonitis, as well as the extent of the spread of the infectious focus.
Early treatment for medical care determines the prognosis of the course of the disease. Therefore, if there is an intense pain in the abdomen, which does not decrease after taking anesthetic drugs, nausea, vomiting, fever, you should immediately seek medical help. In this case, urgent hospitalization in a medical institution is necessary.
Treatment of peritonitis
Treatment of peritonitis is only surgical. As a rule, with a proven diagnosis, an emergency operation is necessary. During the operation, the affected organ should be inspected - the source of inflammation, if necessary - suturing the wall defect, removing the tumor or stopping the bleeding. It is also necessary to remove purulent foci by thoroughly washing the abdominal cavity with solutions of antiseptics, for example, Ringer's solution. With widespread peritonitis, additional flushing may be necessary for the first, second and subsequent days after the operation. After surgical treatment, massive antibiotic therapy and correction of water-electrolyte disturbances are shown.
In 1926, the outstanding surgeon SI Spasokukotsky defined the prognosis of a favorable outcome with peritonitis as follows: "With peritonitis, the operation in the first hours gives up to 90% of recovery, on the first day - 50%, after the third day - only 10%," andmuch has changed since then. Thus, the first stage of the process, when the total poisoning of the body is absent or weakly expressed, with timely treatment ends favorably. With a massive effect of toxins( second stage), the prognosis of recovery is questionable and completely depends on the severity of the damage to organs and systems. The third stage is characterized by almost 100% lethality, since a pronounced inadequacy of organ systems that is not subject to correction develops.
Prevention of peritonitis
Prophylaxis of peritonitis is that every person with a particular disease should be warned as much as possible about possible complications and had a clear algorithm of action with the slightest suspicion of peritoneal inflammation, consisting in the earliest possible call of an ambulance team.
Doctor therapist Sirotkina EV