Peritonitis

Description:

Peritonitis - the peritoneum inflammation which is followed by the general symptoms of a disease of an organism with dysfunction of vitals and systems. Depending on character of an exudate distinguish serous, fibrinous, purulent, hemorrhagic, putrefactive and fecal peritonitis.

Peritonitis symptoms:

The diagnosis of peritonitis is made generally on the basis of a clinical picture of a disease. Inspection and intensive conservative treatment should not detain timely and adequate surgical intervention. Initial symptoms correspond to a basic disease which leads to development of peritonitis (an acute appendicitis, acute cholecystitis, a diverticulitis and so forth). On this background strengthening of a pain syndrome is noted, pain sharply amplifies and quickly extends on all stomach. Language in initial stages is laid over, wet. The stomach is intense in all departments, is sharply painful, symptoms of irritation of a peritoneum positive, percussion morbidity is maximum in a zone of primary center of an infection. It is necessary to define hepatic dullness smoothness or absence it - a sign of perforation of hollow body.

Clinical manifestations depend on a peritonitis stage. Allocate reflex, toxic and terminal stages. In an end-stage the diagnosis does not present special difficulties: Hippocratic face, dry (as brush) coated tongue. The stomach is blown up, intense and painful in all departments, symptoms of irritation of a peritoneum are positive, the peristaltics is absent. Tachycardia, unstable ABP, an oliguria are characteristic. In blood test - a high leukocytosis, shift of the Formula to the left. At a biochemical research - increase in bilirubin, creatinine, urea (hepatonephric insufficiency).

Radiological signs; free gas under a diaphragm dome (perforation of hollow body), gas in anatomically the structures (interloopback or subphrenic abscess) which are not containing gas. Existence of levels of liquid in a small and large intestine confirm paralytic intestinal impassability. At X-ray inspection of bodies of a chest cavity define the atelectatic pneumonic centers, an exudate in a pleural cavity. In diagnostically hard cases apply a laparoscopy.

Peritonitis reasons:

From activators sow microbic associations more often: stafilo-, streptococci, colibacillus, pneumo - both gonokokk and big group of anaerobe bacterias which is given the increasing value recently.

Main reasons for peritonitis: acute destructive appendicitis, perforated stomach ulcer and a duodenum, acute destructive cholecystitis, a diverticulitis of a colon or a diverticulitis of an ileal gut (a mekkeleva of a diverticulum), perforation of a tumor of a colon or a rupture of a caecum at tumoral intestinal impassability, traumatic ruptures of hollow bodies at the closed stomach injury. Less often peritonitis develops after operative measures. At receipt in an abdominal cavity of gastric contents, pancreatic enzymes, bile, blood, urine chemical and toxic peritonitis develops.

Treatment of Peritonitis:

Treatment of peritonitis operational. Loss of time from the beginning of an operative measure threatens with development of heavy complications (septic and hypovolemic shock) with a lethal outcome. At serious condition of the patient preparation for the purpose of correction of volemichesky disturbances and reduction of the patient in a resectable state is necessary short-term (2-3 h). Operation is performed under an intubation anesthesia. As access at diffuse peritonitis apply a wide median laparotomy.

Trailers of operational treatment: 1) sanitation of primary center of an infection (for example, an aptsendektomiya, a holetsistzktomiya, sewing up of a perforated ulcer, etc.) and an abdominal cavity which is washed out isotonic solution of sodium of chloride or 0,25% novocaine with addition of antibiotics and antiseptic agents. Use of a furatsipin is undesirable; 2) drainage of an abdominal cavity: use of drainages from silicone rubber is the most reasonable (usually drain the most sloping sites of an abdominal cavity and subphrenic space). Dvukhprosvetny drainages are convenient;

washing of a drainage through one gleam interferes with a blockage its fibrinny films, etc. Such drainage from silicone rubber can remain in an abdominal cavity to 2 weeks, however periodic pulling up of a drainage for prevention of development of decubitus on a gut wall is desirable; 3) at the expressed paralytic intestinal impassability the nazointestinalny intubation of a small bowel with the subsequent aspiration of intestinal contents is necessary that promotes earlier recovery of an active vermicular movement.

In some cases at a terminal phase of a disease at patients apply peritoneal lavage - flowing washing of an abdominal cavity solutions of antibiotics and antiseptic agents. The method has the advantages (reduction of intoxication, improvement of function of kidneys) and shortcomings (interfere with a natural otgranicheniye of the inflammatory center, natural protective mechanisms are removed). (There are no statistically reliable favorable results, but good results are in some cases received. In recent years with good effect use planned relaparotomies in the postoperative period. In a day after operation carry out relaparotomy with careful washing of an abdominal cavity and drainage. The subsequent relaparotomies make in 1-2 days depending on character and quantity of the separated and general condition of the patient flowing on drainages. In the last decade an inclination of peritonitis methods of an extracorporal detoxication were widely used (blood Ural federal district radiation, hemosorption, a plasma exchange, hyperbaric oxygenation, etc.).

The forecast is always very serious. The lethality depends on the reason of peritonitis, terms of operational treatment (see appropriate sections). Operation against the background of septic shock gives a lethality of 80-90%.