Inflammation of the peritoneum is called peritonitis. This condition is extremely dangerous for the body, as it violates the functioning of all the vital organs. Acute peritonitis requires emergency medical care, otherwise a short time it can lead to death.
Causes of peritonitis
Peritonitis caused by an infection or foreign matter (pancreatic enzymes, bile, etc.) penetrated into the abdominal cavity. The main reason for the infection penetrates to the peritoneum is purulent fusion organ abdominal trauma hollow abdominal trauma, including operating in the area of the abdominal cavity.
The most common infectious agents causing peritonitis are streptococci, staphylococci, Pseudomonas aeruginosa, Escherichia coli, gonococci, pneumococci, Mycobacterium tuberculosis, as well as anaerobic organisms.
The main cause of infectious peritonitis is an acute suppurative appendicitis, more rarely perforation of gastric ulcer and duodenal ulcer, acute purulent cholecystitis, acute pancreatitis, acute purulent inflammation of the pelvic organs, ruptures of the stomach, intestines, bladder, resulting in injury or far-gone cancer.
Types of peritonitis
Peritonitis is the primary and secondary.
Primary, aka idiopathic or viral peritonitis, is extremely rare, as a result of primary infection in the abdominal cavity and the peritoneum. In the case of peritonitis viral infection penetrates into the peritoneum through hematogenous or lymphatic vessels, and occasionally through the fallopian tubes. The share of peritonitis virus is not more than 1% of all cases.
Depending on the cause, allocate:
- Infectious peritonitis;
- Perforated peritonitis;
- Traumatic peritonitis:
- Postoperative peritonitis.
By the nature of the inflammatory exudate:
- Serous peritonitis;
- Purulent peritonitis;
- Hemorrhagic peritonitis;
- Fibrinous peritonitis;
- Gangrenous peritonitis.
According to the degree of distribution:
- Local peritonitis;
- Total (total) peritonitis.
- Circumscribed (encysted) peritonitis;
- Diffuse peritonitis.
As traumatic factors:
- Bacterial aka microbial or infectious peritonitis. It is divided in turn into a non-specific, caused by pathogens came from the gastrointestinal tract, and specific, caused by other pathogens;
- Aseptic peritonitis damaging factor is not an infection and toxic effects of a substance. It may be hit the gastric juice, pancreatic enzymes, blood, bile, etc.
- Special peritonitis (katseromatozny, parasitic, rheumatoid, granulomatous).
The symptoms of peritonitis
Acute peritonitis has several phases of development:
- Reactive phase lasts 12 to 24 hours;
- Toxic phase duration of 12 to 72 hours;
- The terminal phase occurs after a period of 24 to 72 hours of onset and lasts a few hours.
Thus, acute peritonitis can lead to death within 24 hours of onset.
The symptoms of peritonitis in the primary, reactive phase coincide with the first symptoms of the underlying disease, which become sharper and brighter. Typically, the occurrence of acute peritonitis suggests intensified pain spreading to the entire abdomen, marked the peak of pain in the area of primary focus. The abdomen becomes tense, doskoobraznym. Very positive symptoms of irritation of the peritoneum, the most famous of which is a symptom of Shchetkina-Blumberg: palpation of the abdomen with the rapid withdrawal of hands there is a sharp pain. The patient tries to lie on your side with those given to the stomach legs ("the pose of the embryo"), any attempt to change posture increases the pain. This quiet, faint moans. Body temperature increased.
The symptoms of peritonitis in the toxic stage can be misleading in that the apparent improvement occurs. The pain subsides, it ceases to be a tense abdomen, the patient enters a state of lethargy or euphoria. His features sharpened, appear pale, possible nausea and vomiting. Sometimes it takes a painful vomiting debilitating character. Reduced urine excretion and intestinal peristalsis, and even when listening inaudible normal bowel sounds (a symptom of "deathly silence"). The mucous membranes of the mouth dry, but fluid intake is difficult because of the lethargy or vomiting. About 20% of patients die in this step.
The symptoms of peritonitis in the terminal stage show deep frustration functions of all body systems and the occurrence of decompensation phase, when the body's defenses are depleted. The patient is in prostration, indifferent to what is happening, sometimes in this stage comes intoxication mental disorder. A person acquires an earthy hue, eyes and cheeks sink (so-called "Hippocratic face"), acts as a cold sweat. Available profuse vomiting putrid contents of the small intestine. Develop shortness of breath and tachycardia, body temperature, increased before falling. Abdomen swollen, painful, but there is no protective muscle tension. Symptom Shchetkina-Blumberg becomes bland. In this step, it kills about 90% of patients.
Diagnosis of peritonitis
Diagnosis is based on characteristic symptoms of peritonitis and blood testing data. The blood test is observed purulent toxic leukocyte shift. Used X-ray diagnosis and ultrasound of the abdomen, and in cases of doubt - laparoscopy.
It should be noted that the diagnosis of peritonitis must be as urgent as the condition requires emergency treatment.
Treatment of peritonitis
Treatment of peritonitis is carried out in the department of emergency surgery. For suspected acute peritonitis can not take food, water and painkillers, use hot water bottles and put an enema, the patient should keep the supine position. The basis of the treatment of peritonitis, except in rare cases (delimited peritonitis, agony, etc.) Is a surgical procedure.
Before the operation, carried out training designed to at least partially stabilize the patient's condition. Training consists of fill fluid balance, removal of painful shock and normalize blood pressure.
Surgery is the treatment of peritonitis is performed under general anesthesia. During the operation, eliminate the primary focus of infection, inflammatory exudate is removed, washed the abdominal cavity with antiseptics and set drains. Then restore intestinal obstruction, developed as a result of sepsis, eliminate intestinal impaction. After surgery, comes the turn of medical treatment of peritonitis, which applies an active antibacterial therapy and therapy aimed at maintaining vital functions.