Peritonitis is an inflammation of the peritoneum. This disease is considered within the framework of the concept of an acute abdomen, which is characterized by pain with muscle tension in the region of the anterior abdominal walls. Despite the fact that every year the treatment technique is being improved more and more, this pathology does not become less dangerous. Mortality rates due to peritonitis are still extremely high. For example, with a local form of peritonitis, the mortality rate is six percent, and with spilled - more than forty-five. About what symptoms are observed with peritonitis, what are its causes and what needs to be done to cure the patient, we will tell further.
Peritonitis and its causes
The peritoneum is a serous membrane covering the organs of the abdominal cavity. The peritoneum lining the inner walls of the abdomen is called parietal, and the surface of the organs is called visceral. Its total area is approximately 2m2.
The peritoneum hasabsorption capacity, which is referred to as the resorptive function. At the same time, it can secrete fluid along with fibrin into the abdominal cavity. This ability is called exudative function. Normally, such processes are balanced, and only a certain amount of fluid is contained in the abdominal region. During pathological conditions, the process of exudation is activated, due to which excess fluid can accumulate in the abdominal region in a significant amount.
So, what are the causes of peritonitis?
It can be primary, when the disease develops due to the entry of microorganisms into the abdominal region with the flow of lymph or blood, and secondary, when the pathology is formed as a result of inflammation, perforation and damage to organs that are in the abdominal cavity. There are the following reasons that lead to the occurrence of peritonitis:
- The appearance of inflammatory processes occurring in the abdominal organs, for example, conditions such as appendicitis along with cholecystitis and salpingitis.
- The process of perforation in the organs of the abdominal region. For example, this can occur in the stomach or intestines in the presence of a peptic ulcer. In addition, peritonitis after appendicitis occurs very often or after destructive cholecystitis, as well as with the development of ulcerative colitis.
- Presence of damage to the organs of the abdominal region.
- Operations that were performed on the organs of the abdominal region. Peritonitis after caesarean section is common.
- Development of hematogenous peritonitis, for example, as a result ofpneumococcal and streptococcal infections.
- The appearance of inflammatory processes of any origin that are not associated with the abdominal cavity (for example, purulent processes that are localized in the retroperitoneal tissue).
Forms of illness
The causes of peritonitis are of interest to many. There is a bacterial and aseptic form of the disease. The causative agent of the bacterial form of this pathology can be various aerobic microorganisms in the form of Escherichia or Pseudomonas aeruginosa, as well as Klebsiella, Proteus and Staphylococcus aureus. Also, the bacterial form is provoked by anaerobic parasites in the form of bacteroids, clostridia and peptococci. It often happens that microbial associations provoke peritonitis, that is, a combination of several microorganisms at once.
Aseptic peritonitis can develop during contact of the peritoneum with blood, gastric or intestinal contents, and, in addition, with bile or pancreatic juice. It is interesting to note that after a few hours, microflora may be involved in the process, as a result of which aseptic peritonitis acquires a bacterial nature.
Varieties of peritonitis
Depending on the prevalence of the pathological process, the following forms of peritonitis are distinguished:
- With local peritonitis, only one anatomical section of the abdominal region is involved.
- Against the background of a common type, from two to five anatomical sections of the cavity are involved.
- With the total type, six anatomical sections of the abdominal region are involved. So you need to understand thatperitonitis after surgery is not excluded.
It is equally important to consider the type of exudate. Thus, depending on the exudate, the following forms of peritonitis are distinguished:
- Development of the serous form.
- Fibrinous form of peritonitis.
- Purulent form of pathology.
- Hemorrhagic form.
- Biliary form of peritonitis.
- Fecal form.
- Mixed disease.
The development of peritonitis is different. It can be acute or chronic. The chronic type of the disease is more common against the background of systemic infections of the body, for example, with syphilis or tuberculosis. Acute peritonitis can occur in three phases, ranging from reactive to toxic and terminal.
The first signs of peritonitis are recorded in patients in the first twenty-four hours of the disease. At this time, there is swelling of the peritoneum, and, in addition, exudation with the loss of fibrin. In this case, the local symptoms of the disease will be especially pronounced in the clinical picture. The second toxic stage develops after forty-eight hours. During this period, there is an increase in toxicosis, as a result of which the general intoxication symptoms prevail over the local ones. The third terminal stage develops after seventy-two hours. At this time, there is a strong intoxication. Next, find out what are the symptoms of peritonitis.
Symptoms of the disease
All symptoms observed in peritonitis are divided into local and general. Local symptoms appear in response to the occurrenceirritation of the peritoneum with exudate. In addition, the peritoneum can be irritated by bile or stomach contents. Symptoms of peritonitis include the appearance of abdominal pain along with muscle tension in the abdominal walls.
There are also positive symptoms of peritoneal irritation, which the doctor manages to identify during the examination. General symptoms, as a rule, develop with intoxication of the body. These are non-specific signs in the form of fever, weakness, tachycardia, nausea, vomiting, and confusion. In addition, patients have not only symptoms of inflammation of the peritoneum, but also signs of the underlying disease that provoked the pathology.
Symptoms of the first stage of pathology
The first symptom of peritonitis is a constant, but at the same time not abating pain in the abdomen, which continues to increase with a change in position. In this regard, the patient lies, as a rule, on his back or on his side with his knees pressed to his stomach, trying not to move once again. The localization of discomfort directly depends on the location of the pathological process in the peritoneum.
During the examination of the patient, the doctor manages to determine the tension of the muscles of the abdominal wall. At the first stage of peritonitis, positive symptoms of peritoneal irritation are noted. To determine the Blumberg symptom, you should slowly press on the stomach, fixing your hand on it for a couple of seconds, and then pull it back sharply. In the event that at this moment a strong, and at the same time sharp pain occurs, this will mean that a personperitonitis.
Mendel's symptom is determined by tapping the entire area of the abdomen. According to the patient's reaction, doctors can determine not only the increase in pain, but also the location of the pathological process. Of the general symptoms, patients note an increase in temperature along with tachycardia, increased pressure, dry mucous membranes, as well as nausea and vomiting.
How do signs occur in the second stage of peritonitis?
The second stage of the disease and its main symptoms
At this time, the pain in the abdomen becomes less pronounced. But at the same time, the muscle tension of the abdominal walls, as well as the symptoms of their irritation, is present, becoming less obvious. In the foreground, as a rule, there are such signs as stool retention with flatulence and bloating, which is caused by intestinal paresis. Profuse vomiting with a fetid odor may be noted.
Further there is an increase in general intoxication symptoms. Patients have an increased heart rate, which is more than one hundred and twenty beats per minute, and blood pressure also drops dramatically. The temperature rises, and the tongue from the oral mucosa becomes dry, facial features are sharpened.
The third stage of pathology and its symptoms
Intoxication at this stage becomes even brighter. As a result of dehydration, the patient's skin begins to turn pale, and the face becomes sharp, the mucous membrane of the mouth with the tongue, as a rule, is dry. Heart palpitations with low blood pressure may persist, and breathing may be rapid and shallow.
In the third stage, the patient's stomach is stronglyswollen, and peristalsis is completely absent, while profuse vomiting is observed, against the background of which gastric and intestinal contents come out. Due to the severity of intoxication, the nervous system begins to suffer, as a result of which the patient may be adynamic or fall into euphoria. In addition, delirium and confusion are noted. Now let's look at what research is being carried out as part of the diagnosis of this pathology.
Diagnosis of peritonitis
How to identify such a dangerous disease? If there are symptoms of an acute abdomen, the following medical tests are performed:
- Carrying out a clinical blood test. As a rule, as a result of taking this analysis, patients have leukocytosis along with a shift to the left of the leukocyte count.
- Performing a rectal and (for women) vaginal examination. This diagnostic method allows you to determine the pronounced soreness of the intestinal walls, which is due to irritation of the peritoneum.
- Performing an x-ray examination of the abdominal organs. This method allows you to determine the darkening of the peritoneum, which is due to the accumulation of exudate there.
- Ultrasound examination of the abdomen to detect the presence of excess fluid.
- Performing laparocentesis - puncture of the abdominal cavity. Such a study makes it possible to study the contents of the abdominal region.
- Perform laparoscopy if there is doubt about the diagnosis.
Next, we will find out how the patient is treated withperitonitis.
Treatment for this pathology
Peritonitis is treated promptly. The goal of surgery is to eliminate the cause that led to the development of the disease. In addition, drainage of the abdominal cavity is carried out.
What is done with peritonitis in surgery? The sequence of actions is as follows:
- Performing preoperative preparation, which cleans the digestive system and administers anesthesia.
- Laparotomy. In this procedure, the anterior abdominal wall of the abdomen is cut.
- Elimination of the source of peritonitis. For example, the appendix can be removed, and the ulcer is also resected, the walls of the organ are sutured.
- Performing an abdominal debridement. As part of this procedure, washing occurs with the help of antiseptic solutions.
- Performing bowel decompression.
- Introduction of drainage into the abdominal area.
- Wound closure.
The prognosis for subsequent recovery will be better the sooner the operation is performed. It is considered optimal to carry out the operation in the first few hours of the disease. Surgical intervention, which was carried out a couple of days after the onset of the first symptoms, significantly reduces the chances of a patient recovering. Therefore, if you experience pain in the abdomen, in no case should you hesitate, you need to urgently consult a doctor.
Treatment of peritonitis is usually supplemented with medication. The goal of drug therapythe elimination of pathogenic microflora along with the correction of metabolic disorders is presented. The following groups of medicines are used:
- Antibiotics. Antibiotics with a wide spectrum of effects are predominantly used, for example, Gentamicin is used along with Sigmamycin, Benzylpenicillin, Ampicillin and Ceftriaxone.
- Using detoxifiers. In this case, for example, a ten percent solution of calcium chloride is used.
- Using infusion solutions of glucose, gemodez and so on.
- Use of colloidal agents and protein blood products.
- Using diuretics such as Furosemide and Mannitol.
- Using non-steroidal anti-inflammatory drugs such as Ibuprofen with Paracetamol.
- Using antiemetics like Metoclopramide.
- Use of anticholinesterase agents, such as Prozerin. It is used to prevent the occurrence of intestinal paresis.
You should pay attention to the fact that if you experience pain in the abdomen, you can not independently prescribe pain medication for yourself. This can lead to the fact that the symptoms of the disease become less pronounced and doubtful, which makes it extremely difficult for the doctor to make the correct diagnosis in time.
The consequences of peritonitis are very serious, even fatal.
What should be the postoperative care?
After surgery, it is important for the patient to continue medical treatment in order toto avoid complications. Already on the second day after the operation, parenteral nutrition should be started. The volume of infusion treatment is approximately 50-60 milliliters per kilogram of body weight per day. A special diet is introduced after peritonitis. Immediately after the restoration of intestinal motility, they switch to the enteral type of nutrition. Against the background of such nutrition, the mixtures are administered using a probe through the nose and mouth. The composition of nutrient mixtures and the duration of such feeding is determined by the doctor. It's all very individual.
Against the background of the positive dynamics of the restoration of the normal functioning of the intestines, the patient is transferred to a natural diet. This becomes possible, as a rule, not earlier than on the fifth day after the operation. It is very important that the patient was on a low-calorie diet. During this period, you should eat low-fat meat broths, vegetable purees, jelly and compotes. Gradually, you need to increase the calorie content of the diet and add dairy products with meat and eggs to it. It is forbidden to use saturated meat broths, smoked meats, spices, confectionery, chocolate, coffee, carbonated drinks and legumes.
Several times a day, doctors should examine the postoperative wound, paying attention to the cleanliness of the dressing, and, in addition, to the degree of wetting. The bandage should be changed regularly. During the change of the dressing, the rules of antisepsis are observed, preventing the displacement of the drainage tube. If you follow all the recommendations of the attending physician, the treatment of the disease will be successful.
