Peritonitis abdominal cavity: symptoms, treatment, causes

Peritonitis - a process of inflammation of the peritoneum. In peritonitis violation occurs due to the strong organ functioning intoxication. The connective tissue of the peritoneum envelops all of the internal organs of the abdomen and serves limiter between the internal environment of the abdominal cavity and the abdominal muscles.

When exposed to pathogens and chemical agents on the surface of the peritoneum, it is able to allocate special substances which cropped this process. If the amount of pathogenic factors is large, the peritoneum is involved in inflammation and peritonitis occurs. Peritonitis - it is a very life-threatening condition. When it occurs, it requires immediate medical assistance and emergency treatment, or possible death.

What it is?

Peritonitis - an inflammation of the parietal and visceral sheets of peritoneum, which is accompanied by severe general condition of the body. The general definition does not fully reflect the problematic diseases: from the point of view of practical surgeon abdominal abscesses should be excluded from the general definition.

As a rule, peritonitis threaten the patient's life and is a medical emergency. Prognosis in case of untimely or inadequate treatment of peritonitis prognosis is very unfavorable.

Causes of

Peritonitis is the primary when the disease develops as a result of microbial ingress into the abdominal cavity with blood or lymph, and secondary when the disease develops during inflammation, perforation, damage to organs in the abdominal cavity.

There are the following reasons leading to the occurrence of peritonitis:

1. Damage of the abdominal cavity;
2. Operations carried out on the abdominal organs;
3. Hematogenous peritonitis (pneumococcus, streptococcus, etc.);
4. Inflammatory processes in abdominal organs (appendicitis, cholecystitis, Salpingitis etc.);
5. Inflammation of any origin, is not associated with the abdominal organs (phlegmon ventral abdominal wall, purulent processes localized in the retroperitoneal fat).
6. The perforations in the abdominal (stomach or duodenum 12 organs during peptic ulcer disease, appendicitis at gangrenous or phlegmonous appendicitis, gall bladder at a destructive cholecystitis, colon at ulcerative colitis).

Distinguish between bacterial and aseptic peritonitis. Activators bacterial peritonitis are both aerobic microorganisms (Escherichia coli, Klebsiella, Proteus, Pseudomonas aeruginosa, Staphylococcus) and anaerobic (Bacteroides, Clostridium, peptokokki). Peritonitis is often triggered by microbial association, ie a combination of several microorganisms.

Aseptic peritonitis develops in contact with the blood of the peritoneum, gastrointestinal contents, bile, pancreatic juice. It is noteworthy that after a few hours in the pathological process involves the microflora and converted into aseptic peritonitis bacterial.

The symptoms of peritonitis

All of the symptoms observed in peritonitis, can be divided into local and general. Local symptoms occur in response to stimulation of peritoneal exudate, bile, gastric contents. These include abdominal pain, muscle tension anterior abdominal wall, as well as positive symptoms of peritoneal irritation, which can not identify the doctor at survey.

Common symptoms develop on the background of intoxication. This non-specific symptoms such as fever, weakness, tachycardia, Nausea, vomiting, confusion. In addition, the patient is observed not only signs of inflammation of the peritoneum, but the symptoms of the underlying disease, peritonitis provoked.

The symptoms of peritonitis abdominal cavity through the stages:

1. Reactive stage. The initial phase is characterized by a predominance of local symptoms and the initial development of the common. Its duration is from several hours to several days. In acute purulent peritonitis its duration is limited to 24 hours. In this step, the patient is forced to a position generally supine with those given to the abdomen down. There are such common symptoms as temperature and heart palpitations. Temperature caused vital activity of bacteria and their penetration into the blood. The degree of temperature rise is directly proportional to microbial pathogenicity. Thus, with streptococcal and staphylococcal peritonitis temperature rises to 39 - 40 degrees Celsius. When TB - 38 degrees. Simultaneously with the raising of the temperature quickens the number of heart beats. At this stage of the disease it is associated with increased temperature. It is known that for each degree raised heart rate increases the number of its 8 beats per minute. At this stage, as nausea and vomiting. Language patient becomes dryish and taxation. On examination of the patient revealed sparing superficial breathing. With moderate pain syndrome, a clear conscience, at a painful shock - confused. Also at this stage it is detected objective signs of peritoneal irritation, such as symptom Shchetkina-Blumberg.
2. Toxic stage. This step lasts 24 to 72 hours. It begin to prevail the common symptoms, which are caused by the general intoxication, disturbances of water and electrolyte metabolism and metabolic disorders. Toxins from the blood and lymph spread throughout the body. Primarily, they reach the liver and lungs, resulting in developing hepatic failure and pulmonary distress. Breathing becomes frequent, superficial, sometimes intermittent. The patient continues to torment vomiting, vomit while becoming malodorous. Major complications at this stage are related to dehydration and water-electrolyte disturbances. In connection with the violation changing vascular tone and vascular permeability (all due to the action of toxins), the liquid seeps into the peritoneal cavity. Angidremii developing condition, which is characterized by reduction of the liquid level in the body. Patient thirsty, that does not go on drinking. Language becomes dry, furred brown bloom. Blood pressure drops and compensatory heart rate is increased to 140 beats per minute. At the same time, due to hypovolemia (blood pressure lowering) heart sounds become deaf and weak. Frequent vomiting leads to loss of not only water but also salts organism. Because of hypokalemia and hyponatremia may occur convulsions or arrhythmias. The patient's condition is further exacerbated when oliguria develops. Thus the daily urine volume is reduced from the norm in 800 - 1500 to 500 ml. It is known that the urine excreted displays all metabolic products. These include urea, uric acid, indican. However, when oliguria they do not appear, and remain in the body. This leads to greater intoxication. At the same time, local peritonitis symptoms become blurred. Muscular tension disappears, to be replaced comes bloating. At this stage of developing bowel paresis, which is characterized by the absence of its peristalsis. Also subsides or disappears completely pain that is associated with the accumulation of fluid in the peritoneal cavity. If you do not take urgent measures, this step can go to the terminal.
3. End-stage. It develops after 72 hours or more from the beginning of the disease. It is characterized by dehydration and development prekomatosnoe state. The patient's face in this step corresponds to the descriptions Hippocrates (facies Hippocratica). Features such person sharpened, eyes and cheeks sink, complexion becomes sallow hue. The skin becomes very dry and tightened to such an extent that whiskey pressed. Confused consciousness, the patient usually lies still. Abdomen greatly distended, palpation it is painless. Pulse patient with filiform intermittent respiration. Today, end stage, of course, occurs only rarely. Intensity of local and general symptoms of peritonitis depends on the extent of its distribution and causes of the disease. Classic phasic flow is observed in diffuse peritonitis. When symptoms of localized forms not so pronounced.

Diagnostics

Diagnosis of typhoid peritonitis includes a thorough history and evaluation of the patient's complaints. Specified chronic pathology of the digestive system, how the disease began, for him, the severity of the pain and intoxication syndromes, disease duration (up to 24 hours, two days, or 72 and more hours).

Instrumental methods of examination:

• Ultrasound of the abdomen (on indications and pelvis);
• radiography of the abdominal cavity (for ulcer perforation - the presence of free gas, at ileus - Klojber bowl);
• laparocentesis (puncturing the abdominal cavity - obtaining massive effusion);
• puncture through the posterior vaginal fornix (pelvic inflammatory processes);
• diagnostic laparoscopy.

From the research laboratory methods used:

• complete blood count (leukocytes rise to 12,000 and higher or reduction of leukocytes to 4000 and below, the shift to the left, the acceleration ESR);
• biochemical analysis of blood (albumin, liver function enzymes, sugar, pancreatic enzymes, etc.);
• general urine analysis;
• determined by acid-base status.

When the clinical examination is estimated pulse (120), blood pressure (marked decrease), respiratory frequency and stomach. Palpable abdominal wall and listened to the cavity of the abdomen, signs of peritoneal irritation are determined.

complications

Complications depend on the specific type of inflammation. The most common include:

1. Vetsidiviruyuschaya ileus - have a close connection with the above described spikes, because they lead to the obstruction of the intestinal contents.
2. Intraperitoneal adhesions (abnormal permanent connection between the two surface portions inflamed peritoneal adhesions can sometimes arise between the peritoneum and intestine);
3. Intraperitoneal abscesses and subdiaphragmatic - are closed cavities containing pus, separate from the rest of the abdominal cavity by soldering. Their opening can be the starting point for re-peritoneal inflammation.

Treatment consists primarily in operating and eliminating causes inflammation of the peritoneum, for example, binding of gastric ulcers or appendectomy. In addition, treatment can be used in the form of antibiotics and analgesics.

How to treat peritonitis?

According to present views, one of the main factors determining the severity and poor outcome peritonitis, it is an endogenous intoxication syndrome.

In the initial stages of development are widely and successfully used with radical surgical techniques readjustment primary lesion and the peritoneal cavity. However, in the first place, it is not always possible to carry out a radical reorganization of purulent focus; secondly, the time of surgery inflammation in the peritoneal cavity can acquire the character of a generalized infection. Proceeding from the above, the concept of interest in modern medicine to methods of removing toxic products from the intestinal lumen.

It is logical to increase the detoxification effect, achieved by draining the gastrointestinal tract in combination with enterosorbents. In this regard, justified the search for such enterosorbents which would possess all the good qualities granular sorbents, but they differed from them flowability and acquired the ability to pass through the various drainages. The experimental data and clinical observations indicate that enterosorption using polyphepane can be used in a complex of measures to combat endotoxicosis with diffuse peritonitis.

With a few exceptions (limited peritonitis of gynecological origin) diagnosis of "acute peritonitis" implies the need for urgent surgical intervention to identify and eliminate the source of peritonitis, readjustment.

On the need for more timely treatment expressed in S. 1926 AND. Spasokukotsky: "When peritonitis operation in the early hours to give 90% recovery, on the first day - 50%, after the third day - only 10%." It should be noted that there were no antibiotics in 1926, which dramatically increased the percentage of recoveries.

After operation

Postoperatively, there may be some problems with the normal functioning of the bowel, severe pain, the development of septic complications. recommended:

• monitoring of patients, hourly estimate of respiratory rate, heart rate, urine output, central venous pressure, discharge drain;
• infusion therapy is performed by colloidal and crystalloid solutions;
• for warming patients infusion medium warmed to body temperature;
• ventilate the lungs for 72 hours for sufficient oxygen supply of organs and tissues;
• glucose solution was administered through the nasogastric tube;
• early recovery of intestinal peristalsis;
• prevention of pain. Narcotic analgesics used in combination with non-steroidal anti-inflammatory drugs. Use fentanyl, morphine, ketorolac.

prevention

Peritonitis is usually a complication of existing abdominal diseases. He often develops on the background of appendicitis, pancreatitis, gastric ulcer. The purpose of the prevention of peritonitis - informing the public about its dangers and timely diagnosis of diseases leading to it.

Forecast

The duration of treatment depends on the causes of peritonitis disease and on the severity.

The average is 2-4 weeks, but in advanced and the process of running a poor prognosis. When the term of up to 24 hours at peritonitis prognosis favorable in general, when the term of above 24 hours mortality from 20 to 90%.