Peritonitis is one of the oldest problems facing the surgery, and at the same time she to this day has not lost its relevance. Peritonitis — inflammation of the serous membranes covering the internal organs and the abdominal cavity (peritoneum). This state is accompanied by the disruption of the functioning of internal organs and systems and the symptoms of General intoxication.
Often peritonitis arises as a complication of other serious diseases, such as ulcerative colitis, acute pancreatitis, appendicitis, liver disease, dysentery, ulcer perforation of the stomach or duodenum 12.
Causes of peritonitis:
By and large, the cause of peritonitis one — hit any foreign substance (enzyme of the pancreas, bile) or pathogenic (opportunistic) microorganisms into the abdominal cavity. This “unauthorized” penetration, too, has its reasons, chief among them — the inflammatory lesion, followed by purulent fusion of the abdominal cavity and injuries of the abdominal organs (including after surgery).
If we talk about the microorganisms that most commonly cause peritonitis, here they are by name: Staphylococcus, Streptococcus, E. coli, Pseudomonas aeruginosa, pneumococcus, gonococcus, Mycobacterium tuberculosis.
Infectious peritonitis is often a result of acute phlegmonous appendicitis, rarely — perforation of gastric ulcer and 12 duodenal ulcer, acute suppurative cholecystitis, acute pancreatitis, tears of the digestive system and bladder (injured or neglected tumors).
Types of peritonitis
From the previous chapters it is already possible to conclude that there is infectious, perforated, traumatic and postoperative peritonitis. This classification of peritonitis depending on the etiology. But there are other ways to classify the disease. For example, based on the nature of the inflammatory exudate, it is possible to allocate serous, hemorrhagic, purulent, fibrinous and gangrenous peritonitis. The degree of proliferation, local and diffuse (diffuse) peritonitis.
Symptoms of peritonitis
The initial phase of peritonitis “merges” with that of the underlying disease. The first symptom of peritonitis is increased pain, which totally affects the entire stomach area with the highest pain at the site of the primary tumor. The abdominal muscles tone increases, some figuratively compares the hardness of the muscles in this period with a washboard. Another glaring symptom that characterize peritonitis, is called the symptom Shchetkina-Blumberg: if you polerowanie belly quickly pull up the hand, there is a sharp pain. In peritonitis, the patient instinctively tries to lay on my side and pressed his knees to the stomach (the so-called fetal position), to move, the pain intensified. The patient weakens, the speech becomes unintelligible. The temperature is rising.
For the initial phase should be toxic. The midpoint between these two stages are very clearly visible: while the toxic stage the patient gets better, the pain subsides, the abdomen relaxes, there are signs of euphoria or, conversely, retardation. Face pale, starts with nausea and vomiting. Due to fluid loss, reduced urine flow, mouth drying up, but because of the vomiting becomes impossible to rehydrate. The intestines as it freezes, not showing any signs of peristalsis. Mortality at this stage is 1 to 5.
The last stage is the terminalwhere the body’s defenses are completely depleted. The patient is not quite sane, falls into prostration, does not respond to external stimuli, comes the so-called substance-induced mental disorder. Vomiting appears in the putrid contents of the intestines. Quickens the pulse, shortness of breath, body temperature decreases. The mortality rate in the terminal stage approaches 100%.
Peritonealdialyse diagnosis of peritonitis
The severity of symptoms of peritonitis allows to diagnose with a high degree of confidence already at survey of the patient. As a “control shot” blood test, which has purulent toxic shift of leukocyte formula. Also used x-ray and ultrasound. It is vital to identify the peritonitis at the initial stage, as this disease requires urgent treatment.
The treatment of peritonitis
To treat peritonitis is possible only surgically. And the delay could lead to death, and with very high probability.
In the surgical treatment primarily begin with the decontamination of the primary infectious focus and abdominal cavity. For this purpose, use isotonic solution of sodium chloride or 0.25% solution of novocaine in combination with antibacterial agents and antiseptics (with the exception of furatsilina). Then effect drainage of the abdominal cavity, i.e., form a path for the outflow of the inflammatory exudate with drainage of silicone rubber. Drainage may remain in the inflammation up to 2 weeks.
Sometimes in the terminal stage of peritonitis use so-called peritoneal lavage. This flow-through lavage inflammation — abdominal cavity with antiseptic solutions and antibiotics.
In recent years, increasingly used method of planned relaparotomy re — laparotomy in the postoperative period, which occurs after the day after surgery and is completed by washing the abdominal cavity with the installation of drainage. In a further relaparotomy was carried out every 2 days, based on the patient’s condition and the amount of discharge for the drainage of exudate.
Over the past 15 years, the popularity gained methods ekstrakorporalnoj therapy (hyperbaric oxygenation, ultraviolet irradiation of blood, plasmapheresis, hemosorption).
Prevention as such when there is no peritonitis. Only, if it can be called preventive, it is worth once again mentioning the importance of early hospitalization and emergency treatment of patients with peritonitis.