Peritonitis

Peritonitis call a peritoneum inflammation. This state is extremely dangerous to an organism as breaks functioning of all vitals. Acute peritonitis demands rendering acute medical assistance, otherwise within a short period of time it can lead to a lethal outcome.

Peritonitis reasons

Peritonitis is caused by the infection or a foreign substance (pancreatic enzymes, bile, etc.) which got into an abdominal cavity. The main reason for which the infection gets to a peritoneum is purulent fusion of an abdominal organ, an injury of hollow abdominal organs, an injury including the operating room, in abdominal organs.

The most frequent infectious agents causing peritonitis are streptococci, staphylococcus, a pyocyanic stick, colibacillus, gonokokk, pneumococci, tuberculosis mycobacteria, and also anaerobic microorganisms.

Acute purulent appendicitis is the main reason for infectious peritonitis, perforation of stomach ulcer and a duodenum, acute purulent cholecystitis, acute pancreatitis, acute purulent inflammations of bodies of a small pelvis, ruptures of a stomach, intestines, bladder as a result of wounds or far come tumoral process is slightly more rare.

Types of peritonitis

Peritonitis happens primary and secondary.

Primary, it is idiopathic or viral peritonitis, arises extremely seldom, as a result of primary infectious damage of abdominal organs and a peritoneum. In case of viral peritonitis the infection gets into a peritoneum in the hematogenous way, or on absorbent vessels, occasionally through uterine tubes. No more than 1% of all cases fall to the share of viral peritonitis.

Depending on the reason, allocate:

• Infectious peritonitis;
• Perforative peritonitis;
• Traumatic peritonitis:
• Postoperative peritonitis.

On character of inflammatory exudate:

• Serous peritonitis;
• Purulent peritonitis;
• Hemorrhagic peritonitis;
• Fibrinous peritonitis;
• Gangrenous peritonitis.

On extent of distribution:

• Local peritonitis;
• Widespread peritonitis;
• General (total) peritonitis.

On localization:

• The delimited (sacculated) peritonitis;
• Diffuse peritonitis.

On the injuring factor:

• Bacterial, it is microbic or infectious peritonitis. Shares in turn on nonspecific, caused by the activators which got from digestive tract, and specific which reason other activators are;
• Aseptic peritonitis, a disturbing factor is not an infection, and toxic influence of any substance. It can be hit of a gastric juice, pancreatic enzymes, blood, bile and so forth.
• Special peritonitis (katseromatozny, parasitic, rhematoid, granulematozny).

Peritonitis symptoms

Acute peritonitis has several phases of development:

• The reactive phase, lasts from 12 to 24 hours;
• The toxic phase, duration is from 12 to 72 hours;
• The terminal phase, comes after an interval from 24 to 72 hours from the beginning of a disease and several hours last.

Thus, acute peritonitis can lead to a lethal outcome within 24 hours from the beginning of a disease.

Peritonitis symptoms in an initial, reactive phase match in the beginning symptoms of a basic disease which become more sharply and more brightly. Usually approach of acute peritonitis is demonstrated by the amplified pain extending to all stomach, the peak of morbidity is noted in a zone of primary center. The stomach becomes intense, doskoobrazny. Symptoms of irritation of a peritoneum, the most known of which is Shchetkin-Blyumberg's symptom, are sharply positive: at a stomach palpation at a bystry otdergivaniye of hands there is a sharp morbidity. The patient tries to lie on one side with the legs ("a germ pose") given to a stomach, any attempt of change of a pose strengthens pain. The speech is silent, groans weak. Body temperature is increased.

Peritonitis symptoms in a toxic stage can mislead the fact that there occurs the seeming improvement. Pain abates, the stomach stops being intense, the patient enters a condition of block or euphoria. Its features are pointed, there is a pallor, nausea and vomiting is possible. Sometimes vomiting accepts the painful exhausting character. Urination and a peristaltics of intestines decreases, and even when listening usual intestinal noise (a symptom of "death silence") are not heard. Mucous membranes of an oral cavity dry, however reception of liquid is complicated because of block or vomiting. About 20% of patients perish in this stage.

Peritonitis symptoms in an end-stage demonstrate deep disorder of function of all systems of an organism and approach of a phase of a decompensation when protective forces of an organism are exhausted. The patient is in prostration, is indifferent to the events, sometimes in this stage there comes intoksikatsionny frustration of mentality. The person gets an earthy shade, eyes and cheeks sink down (so-called "Hippocrates's mask"), cold sweat acts. Plentiful vomiting putrefactive contents of a small intestine is possible. The short wind and tachycardia, body temperature before increased develop, falls. The stomach is blown up, болезненнен, but the protective muscle tension is absent. Shchetkin-Blyumberg's symptom becomes poorly expressed. In this stage about 90% of patients perish.

Diagnosis of peritonitis

The diagnosis is made on the basis of characteristic symptoms of peritonitis and data of a blood analysis. In blood test it is observed it is purulent - toxic shift of a leukocytic formula. X-ray diagnosis and ultrasound examination of abdominal organs, and in doubtful cases – a laparoscopy is applied.

It is necessary to tell that diagnosis of peritonitis has to be as much as possible emergency as the state demands urgent treatment.

Treatment of peritonitis

Treatment of peritonitis is performed in department of the emergency surgery. At suspicion of acute peritonitis it is impossible to eat food, water and the anesthetizing drugs, to use hot-water bottles and to give enemas, the patient has to keep lying situation. At the heart of treatment of peritonitis, except for exceptional cases (the delimited peritonitis, a condition of an agony, etc.) surgery lies.

Before operation carry out the preparation directed to at least partial stabilization of a condition of the patient. Preparation consists of completion of balance of liquid, removal of painful shock and normalization of arterial pressure.

Surgical intervention at treatment of peritonitis is carried out under the general anesthesia. During operation eliminate primary infectious center, delete an inflammatory exudate, wash out an abdominal cavity antiseptic agents and establish drainages. Then recover the intestinal impassability which developed as a result of sepsis, eliminate an intestines prelum. After operation there comes the turn of drug treatment of peritonitis what active antibacterial therapy, and also the therapy directed to maintenance of the vital functions of an organism is applied to.