Peritonitis - a life-threatening acute surgical disease that results from inflammation of the peritoneum due to exposure to microbes, food or intestinal contents.
Peritonitis is an indication for immediate hospitalization and emergency assistance in the form of a draining operation of the abdominal cavity.
Causes
Peritonitis can occur upon penetration of microbes, bile, contents of the intestines or pancreatic enzymes in peritoneal cavity between the intestinal loops.
Infection mostly penetrates into the abdominal cavity from the inside, with melt fracture or rupture of a body with contents, at least when it penetrates inside penetrating wounds or injuries, operations. Most often it happens staphylococcus or E. coli, gonococci, other microbes are fewer enzymatic peritonitis.
Mainly cause peritonitis:
- appendicitis,
- ulcers of the stomach and intestines,
- pancreatitis cholecystitis,
- purulent processes pelvis,
- intestine breaks.
Kinds
Peritonitis is of two kinds:
- primary, occurs as an independent pathology as a result of viral or microbial destruction peritoneum,
- secondary occurring as a complication of existing in the abdomen or pelvis infectious processes.
By the nature of secretions into the peritoneal cavity peritonitis may be serous, purulent, fibrinous, haemorrhagic and gangrenous.
The symptoms of peritonitis
Depending on the cause and severity, death from peritonitis available within 1-2 days.
Peritonitis is shown in the initial stage of the disease symptoms, which complicates it. But all the manifestations of the most strong and bright. There is increased pain in the abdomen, extending it to the entire abdomen with the peak in the original outbreak area. The abdomen becomes "character of the board" of density, it dramatically tense.
On examination, symptoms of "irritation of the peritoneum" pronounced, while the patient avoids the inspection and lays down in a pose "embryo", as any movement increase the pain. In this he groans, says quietly or delirious with fever.
As the disease progresses the symptoms subside, giving a false sense of what was better. The abdomen becomes softer, the pain subsides, the patient goes into a state of prostration and euphoria. He abruptly pale, with particular facial features, nausea and vomiting.
Violated the separation of urine and stool, no bowel sounds - in the abdomen, "a symptom of grave silence." Mucous desiccated but liquid reception is difficult, some patients die in this step.
In the terminal stage of peritonitis occurs disorder all vital functions of the body - the patient can fall into a coma, a mental disorder on the background of intoxication. Earthy skin, cheeks and eyes sink, emerges an icy sweat. Maybe profuse vomiting the contents of the small intestine, dyspnea with palpitations, the temperature plummets. Belly swells, painful, but there is no tension in the muscles. In this step, dies 90% of all patients.
Diagnostics
Basis diagnosis - questioning and identification of specific symptoms of peritonitis, changes in the blood analysis with a marked leukocytosis and shift formula toxic to grain. To clarify the diagnosis methods can be used:
- ultrasound diagnosis of abdominal rug,
- roentgen abdominal
- diagnostic laparoscopy.
Sometimes the diagnosis is already in the course of the operation, after opening the abdominal cavity and intestines audit.
Methods of treatment of peritonitis
The treatment takes only surgeons in the surgical department, it is strictly prohibited suspected peritonitis treated at home, wasting precious time, also prohibited warmers and enemas, walking, it is necessary lie.
It should be mandatory surgery with opening of the abdominal cavity with parallel replenishing fluid balance, salts, and the normalization condition to the extent possible. Also need adequate analgesia and pressure normalization.
The operation is performed under general anesthesia, eliminate source of infection, the wound is sutured, or pus removed inflammatory liquid left drains and washed cavity with antiseptic solutions. Tidy the bowels, eliminate inflammation and then proceed to have medical treatment of peritonitis.
Showing courses of powerful antibiotics, dropper with detoxification solutions, preparations for the maintenance of the heart and blood vessels, normalize the breathing and the nervous system.
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%.
