Purulent peritonitis

Description:

Primary bacterial peritonitis meets seldom. He results from penetration of an infection in the hematogenous or lymphogenous way and is called most often by pneumococci, stafilokokka or streptococci. In most cases infection of a peritoneum occurs for the second time, as a result of a purulent disease of any abdominal organ. To a bowl of all a source of peritonitis is purulent appendicitis. The ruptured ulcer of a stomach and duodenum, and also acute cholecystitis are on the second place. Further there are acute pancreatitis, acute intestinal impassability, acute mezenternalny thrombosis, etc.

Symptoms of Purulent peritonitis:

    * the sharp amplifying abdominal pain
    * fever
    * the nausea and vomiting which are not giving relief
    * muscle tension of a front abdominal wall
    * sharp morbidity when pressing on a front abdominal wall
    * Shchyotkin's symptom — Blyumberg
    * The symptom of imaginary wellbeing — after perforation of the patient feels severe pain, but then pain abates as receptors on a peritoneum adapt, (and it is the dangerous moment), but then in 1-2 hours pain develops with a new force as the peritoneum inflammation develops.

Reasons of Purulent peritonitis:

For development of peritonitis disturbance of integrity of all layers of hollow body is not obligatory. Sometimes microbes get into an abdominal cavity at disturbance only of a mucous or serous membrane and cause peritonitis. Penetration of an infection into a peritoneum through an intestinal wall without its perforation can be observed at disturbance of blood circulation in it (thrombosis of vessels of a mesentery) or as a result of defeat by its purulent inflammatory process (acute enteritis, etc.) leading to decrease in its barrier function. In practice peritonitises at which the source of the infection which caused them is in a distance from a peritoneum meet. Such peritonitises, though it is rare, can be observed at quinsy, sepsis, pneumonia, osteomyelitis and other diseases. Them call hematogenous.

Treatment of Purulent peritonitis:

At purulent peritonitis the leading role is played by operational treatment. Its success depends on purposeful general treatment which purpose — compensation of pathophysiological disturbances and fight against an infection and intoxication.

The general treatment begins during the preoperative period, is carried out to time of operation and major importance gets during the postoperative period. First of all, it is necessary to fill volume shortage of plasma its substitutes: amino acids, blood, solutions of electrolytes.

Apply Mannitolum (100 ml, 20%) to maintenance of a diuresis. The diuresis has to make 30-50 ml/h Krom of recovery of OTsK it is necessary to administer the drugs for treatment of multiorgan insufficiency, to carry out parenteral food, and with the advent of a vermicular movement — an enteroalimentation via the probe and already in the presence of a chair — food through a mouth. At respiratory insufficiency there can be necessary a tracheostomy, an artificial respiration in the synchronous mode with moderate positive pressure at the end of a breath. In fight against paresis use a complex of actions: electric stimulation of intestines, perinephric blockade, epidural anesthesia, a diathermy on an abdominal brain, enemas, compresses on a stomach and drugs: прозерин, hypertonic salt solution of chloride sodium, Pituitrinum, sorbitol, sorbite, xylitol.

Fight against intoxication includes: infusional therapy, an artificial diuresis, the hemosorption which is carried out on arteriovenous or veno-venous type by the device UAG-1 through absorbent carbon — CKH-4M-1K, an exchange plasmapheresis, a limfosorbtion, Ural federal district blood, connection of a ksenopechena and ksenoselezenka by means of the device UAG-1 with a capacity of perfusion of 40-50 ml/min. within 45 min., peritoneal dialysis, drainage of a chest lymphatic channel, endolymphatic introduction of antibiotics, an enterosorbtion Polyphepanum or vauleny, the selection endogenous detoxication: polibioniny, cryoprecipitate, blood plasma, ekstradiolpropionaty. For normalization of fabric metabolism vitamins, hyperbaric oxygenation are used.

Antibioticotherapia has to be carried out, since the presurgical period when the antibiotikogramma is not known yet and the bacteriological activator is not installed yet, the most suitable antibiotic at purulent peritonitis is хлорафеникол. At an estimated infection and existence of an antibiotikogramma most often use aminoglycosides, cephalosporins in addition with metronidazole.