Peritonitis( inflammation of the peritoneum) symptoms
Mar 06, 2018
Inflammation of the peritoneum( peritonitis) develops when pathogenic microbes are introduced into it or some chemicals are ingested. The peritoneum is a two-layered membrane that lining the abdominal cavity and surrounds the stomach, intestines and other abdominal organs. This membrane supports the abdominal organs and protects them from infection;but sometimes the peritoneum can become infected with bacteria or other microorganisms. The infection usually spreads from the organs within the abdomen. Inflammation can cover the entire peritoneum or be limited to only one abscess. A rupture anywhere in the gastrointestinal tract is the most common way to penetrate the peritoneum. In most cases, microbes are transferred to the peritoneum directly from an inflammatory focus located in one or another organ of the abdominal cavity( acute appendicitis, cholecystitis, inflammation of the female genitalia, curvature of the intestine, etc.), as well as with penetrating wounds of the abdomen andwith perforation of the hollow organs of the abdominal cavity( perforation of the stomach and intestines, gall bladder, etc.).Less often the infection is hematogenically infiltrated from the inflammatory focus( sore throat, etc.).
Peritonitis is the cause of the critical situation: the muscles in the intestinal wall become paralyzed and the bowel movement stops. However, with the advent of antibiotics, most people completely recover from peritonitis with proper treatment.
There are two forms of peritonitis: spilled, when the inflammation captures most of the peritoneum, and limited, in which the inflammation spreads to a relatively limited area.
The most severe form is diffuse peritonitis, which develops as a result of a sudden entry into the abdominal cavity of gastrointestinal contents( when the hollow organ is perforated), or pus( with an abscess breakout).In these cases suddenly there is a very strong sharp pain in the abdomen. To this, nausea and vomiting soon join. Vomiting or desires on it are repeated all the time. Initially, the vomit contains food residues, and then a greenish liquid appears. The pain in the abdomen is growing, becoming unbearable. The slightest movement of the patient or touching the abdomen causes an aggravation of pain. The stomach becomes tense. When palpation it clearly determines the stress of the abdominal wall. The general condition of the patient deteriorates sharply, the skin becomes pale, the pulse is frequent, the breathing is superficial, the respiratory excursions of the abdominal wall are severely limited or absent. The body temperature rises. And the temperature in the armpit is much lower than in the rectum. In the future, paresis of the intestine and bloating occur. At auscultation intestinal noises in the abdomen are not tapped. The appearance of the patient sharply changes, the eyes fall, the nose is sharpened, the face is covered with cold sticky sweat, cyanosis appears, the tongue becomes dry.
In cases where peritonitis develops due to the transition of inflammation from one or another organ of the abdominal cavity, the general condition and subjective complaints of the patient first remain characteristic of the inflamed organ of the abdominal cavity. But then in the general state there is a sharp deterioration. Pain in the abdomen becomes more diffuse, peristaltic noises are no longer heard. The crucial value for the diagnosis in these cases is palpation. If earlier, tenderness and tension of the abdominal wall were determined in the area of the primary inflammatory focus, then with peritonitis they quickly capture the entire abdomen. There is a sharp deterioration in the general condition of the patient.
With limited peritonitis, only symptoms that are characteristic of inflammation of one or another organ of the abdominal cavity( appendicitis, cholecystitis, adnexitis, etc.) are initially defined. Only after a while, there appear symptoms typical of a limited inflammation of the peritoneum: soreness and tension of the abdominal wall are noted not on the entire abdomen, but on some part of it. In other parts of the abdomen, the abdomen remains milder, less painful, and the stress of the abdominal wall is not expressed, or is slightly expressed.
Treatment is an urgent operation that eliminates the cause of peritonitis. At the same time, intensive therapy is carried out: infusion of isotonic sodium chloride solution, glucose solutions, plasma, blood substitutes, as well as cardiac agents and antibiotics. In the postoperative period, permanent aspiration of gastric contents is established. For the excitation of peristalsis sc, injected with proserin, physostigmine, iv in 10-20 ml of hypertonic sodium chloride solution.