Peritonitis is a fairly serious disease, fraught for the patient not only with a number of complications, but also with a high possibility of death. Knowing the symptoms of diffuse peritonitis is mandatory for everyone. In addition to the signs, we will consider the characteristics, causes of development, varieties of the disease, features of diagnosis, treatment and prevention.
What is this disease?
Diffuse peritonitis is an inflammatory process that affects the parietal and visceral layers of the peritoneum. It can have both aseptic and bacterial origin. First of all, it is associated with a severe general condition of the patient. This is due to multiple organ failure.
Let's turn to anatomy to better understand what diffuse peritonitis is. The sheets of the peritoneum are serous membranes, consisting of mesothelium - a single-layer type of epithelium. They are divided into two categories:
- Visceral epithelium - covers the internal organs of the peritoneum.
- Parietal (or parietal) - lines the walls of the most abdominalarea.
As soon as inflammation occurs in the peritoneum, the serous membrane immediately tries to protect he althy neighboring tissues from the inflammatory focus by creating so-called adhesions. This is localized peritonitis. In the case when such a barrier is unsuccessful (inflammation spreads to neighboring areas), the process already acquires an extensive, diffuse character. Diffuse peritonitis develops.
Statistics says that 15-20% of patients admitted to hospitals with a diagnosis of "peritonitis" need immediate surgical intervention. Mortality among the sick is high - 40-50% of cases.
Diffuse peritonitis of the abdominal cavity doctors refer to a group of pathologies under the general name "acute abdomen". That is, to acute forms requiring immediate surgical intervention.
Causes of aseptic peritonitis
Diffuse purulent peritonitis is considered aseptic if the cause of the inflammation is not associated with foreign pathogenic microorganisms. So what causes disease?
Several reasons stand out:
- Influence of pancreatic enzymes. It manifests itself in acute pancreatitis, peritoneal injuries.
- Hemoperitoneum - the release of blood into the extraperitoneal space. The reasons are the same.
- Rupture of an ovarian cyst.
- Exposure to barium mixture. An extremely rare case. This is the release of a mixture of barium outside the gastrointestinal tract. It is used in X-ray examination of the gastrointestinal system.
Causes of bacterial peritonitis
The aseptic form of the disease, I must say, is quite rare. The most common causes of diffuse diffuse peritonitis are rupture of hollow organs, operations, injuries that led to damage to the organs of the peritoneum and entry of infection into it.
The most common causative agents of the bacterial form of the disease are as follows:
- Own non-specific conditionally pathogenic microflora inhabiting the gastrointestinal tract.
- Varieties of Pseudomonas aeruginosa.
- E. coli.
- Tuberculosis mycobacterium (Koch's wand).
- Gonococcus (causative agent of gonorrhea), etc.
Primary route of disease occurrence
This is a rather rare type of diffuse peritonitis of the abdominal region: it occurs in 1.5% of cases. It develops when bacteria, viruses and fungi enter the peritoneum in three ways:
- Lymphogenic. With lymph through the lymphatic vessels.
- Hematogenous. With blood flow.
- Peritubaric. Through the fallopian tubes in women.
In this case, the disease can also be caused by microorganisms such as pathogens of tuberculosis, gonorrhea, salpingitis.
Secondary route of disease occurrence
Diffuse purulent peritonitis is most often the result of another pathological process. That is, it is a secondary pathology when:
- Complications of diseases affecting the stomach, duodenum, liver and pancreas. Most often, acute diffuse peritonitis causes purulentappendicitis (bursting and oozing appendix).
- Complications of diseases affecting the small intestine. These are perforation of the diverticulum, tumors, acute obstruction of the small intestine, blood clots in the mesenteric vessels.
- Diseases of the large intestine. In particular, perforation of its departments in UC, Crohn's disease, typhoid ulcers, acute intestinal obstruction.
- Injuries to the abdominal organs, followed by the release of an infected mass from them.
- Postoperative consequences. This is damage to the walls of organs by the surgeon, incompetent anastomoses, eruption of sutures and ligatures.
Disease classification
In the medical world, there are several gradations of forms of this disease. Let's briefly introduce them.
Due to occurrence:
- Traumatic.
- Post-op.
- Perforated.
- Infectious.
By presence/absence of pathogens:
- Bacterial.
- Aseptic.
By the nature of occurrence:
- Primary.
- Secondary.
By prevalence in the anatomical areas of the peritoneum:
- Local (or local).
- Limited.
- Diffuse (common).
According to the characteristics of inflammation:
- Diffuse serous peritonitis.
- Hemorrhagic.
- Diffuse fibrinous peritonitis.
- Purulent peritonitis.
According to the type of content poured into the peritoneum:
- Fecal.
- Urinary.
- Biliary.
- Hemorrhagic.
Phases of disease progression
Diffuse fibrinous-purulent peritonitis, like other forms of the disease, develops in several phases:
- Reactive.
- Toxic.
- Terminal.
Each of them is distinguished by a special symptomatology. Therefore, it makes sense to present the stages in detail.
Symptoms of the reactive stage
Diffuse acute peritonitis practically does not manifest itself in the first day of the lesion. If the patient feels unwell, it is associated with the underlying disease.
Further, the reactive stage of the disease begins to manifest itself as follows:
- Severe pain in the peritoneum.
- Vomiting stomach contents.
- Increased body temperature.
- Increased heart rate.
- Unreasonably rapid breathing.
- Dry mouth. Moreover, the patient complains of constant thirst.
- The patient is in an unnatural constrained position. Most often this is the position of the embryo. Due to the fact that in this position the pain subsides a little.
As the inflammatory process spreads to new areas, the patient's condition begins to change, worsen:
- A person practically does not breathe with his stomach - it becomes painful for him.
- On palpation, the specialist determines that the muscles of the abdominal anterior wall are tense.
- Sharply positive peritoneal symptom (Shchetkin-Blumberg).
- Whenvaginal and rectal examination in the pelvic peritoneum appears a sharp pain.
At the end of the second day, there may be an imaginary improvement in the condition with a decrease in symptoms.
The fluid in the peritoneal region at this time will be transparent - fibrous-serous or simply serous type. At the reactive stage, its quantity increases rapidly, and by its end it already becomes purulent.
Symptoms of the toxic stage
The phase occurs 24-72 hours after the onset of the disease. First of all, it is characterized by a sharp deterioration in the patient's condition. Symptoms are noted as follows:
- Increase in body temperature.
- Loss of consciousness.
- Change in breathing rate. It becomes noisy by itself.
- Weak pulse. Sometimes almost threadlike.
- Man is constantly thirsty.
Appearances:
- The patient's face resembles the so-called "Hippocratic mask" - haggard, sunken cheeks, sunken eyes.
- Dry lips.
- The tongue is also dry, overlaid with a grayish coating.
- Patient not breathing from belly.
- The abdomen is board-shaped on palpation (due to muscle tension).
The following symptoms may also be added:
- Reducing the amount of urine excreted by the body.
- Bloating.
- Loss of consciousness.
- Lack of peristalsis of the intestinal tract due to its paresis.
Ultrasound examination shows the presence of free fluid in the abdominal cavity. Her character may bepurulent hemorrhagic or purulent fibrous.
Terminal symptoms
Terminal is the phase that begins 72 hours after the onset of the disease. It is characterized by an extremely serious condition of the patient. The main features are as follows:
- The man is immobilized.
- Depressed consciousness (up to coma).
- Intoxication of the body is visible by the aggravated signs of the previous stage.
- Symptoms of multiple organ failure.
- Threaded pulse.
- Skin bluish, grayish, very pale.
- Weak breathing (sometimes need to be kept alive with a ventilator).
- Renal failure is expressed in a sharp decrease in the volume of urine excreted or in the complete absence of urine.
- Vomiting already intestinal contents (distinguished by fecal odor).
- Progressive intestinal paresis.
- One of the dangerous manifestations is septic shock.
- The abdominal muscles noticeably weaken (in contrast to the extremely tense state in the previous stage).
Death at this stage of the disease is 50% of cases.
Diagnosis of disease
The best salvation from death is early diagnosis of peritonitis. Includes the following activities:
- Acquisition of anamnesis - connection of the condition with injuries, operations on the organs of the peritoneum, etc.
- Assessment of patient complaints, severe clinical symptoms.
- Palpation of the abdomen. Doctor draws attention toperitoneal symptoms and abdominal tension.
- General clinical blood test. The study helps to identify the onset of the inflammatory process by accelerating the ESR, shifting the leukocyte formula.
- Blood biochemical analysis. Pathology can be detected by elevated acute phase markers.
- Overview x-ray examination of the peritoneum. If a hollow organ is perforated, free air will be visible in the cavity.
- Ultrasound of the organs of the peritoneum. Indicates the presence of free fluid.
- Computed tomography.
- Diagnostic laparoscopy. The method is applicable if the above studies do not allow an accurate diagnosis.
- Bakposev of the contents of the abdominal cavity. Establishment of the type of pathogenic microorganism that caused purulent inflammation. This is necessary to determine its sensitivity to certain antibiotics.
Cure disease
The success of therapy depends on a timely diagnosis. Treatment of diffuse peritonitis involves the following activities:
- Surgical intervention. Surgery for diffuse peritonitis - removal or resection (removal of a certain part) of purulently changed organs. Next, the abdominal cavity is washed, treated with antiseptics. The peritoneum is opened by a median laparotomy (an incision along the median contour of the abdomen). The technique allows you to carefully examine the abdominal cavity, gain access to all inflamed organs, sanitize the internal space.
- Elimination of paralyticbowel obstruction with a number of medications.
- Decompression of the gastrointestinal system.
Post-op period
The recovery phase (after surgery) includes the following activities:
- Infusion of solutions capable of restoring the acid-base, water, electrolyte balance in the patient's body.
- Restoring the functions of the liver, kidneys, pancreas, supporting their vital functions.
- Drug therapy - administration of antibiotics. Drugs are used to which the identified microorganism-causative agent is sensitive.
To a patient who has had diffuse peritonitis, experts advise to strictly adhere to the following recommendations:
- Prevention of dysbacteriosis - taking probiotics and eubiotics.
- Proper nutrition - avoiding foods high in sugar, bakery products.
- Predominance of high-fiber food, dairy and sour-milk products on the menu.
Possible Complications
Against the background of diffuse peritonitis, the following pathologies often develop:
- Acute kidney failure.
- Dehydration.
- Toxic shock.
- Congestive pneumonia.
Diffuse peritonitis is a dangerous, rapidly developing disease with a high probability of death. However, there are no specific preventive measures that can protect against this disease. Doctors advise to followa he althy lifestyle, fight in a timely manner even with seemingly frivolous ailments, do not self-medicate, and if alarming symptoms are detected, immediately seek qualified medical help.
