Peritonitis - what is it? Peritonitis: causes, symptoms, diagnosis, treatment
Many people ask the question: "Peritonitis - what is it?" This article is about this dangerous disease.
So, peritonitis is an inflammatory process that can develop in the peritoneum or in the membrane of the abdominal cavity. Most patients and their relatives perceive this diagnosis in a fatal sense. However, some of its forms, subject to timely and proper operation, can be fully cured.
So, we will understand what is peritonitis, the reasons for its occurrence also consider. Generally speaking, the disease has one main reason - the ingress of an extraneous substance (bile, pancreatic enzyme) or pathogenic microorganisms into the abdominal cavity. This “unauthorized” penetration, in turn, also has reasonsnamely, damage to the abdominal organs (including as a result of surgical interventions), inflammatory damage and further purulent fusion of the abdominal organs.
Also, peritonitis can be caused by the following microorganisms: gonococcus, pneumococcus, pyocyanitis, tuberculosis microbes, E. coli, streptococcus, staphylococcus.
Quite often, infectious peritonitis is the result of phlegmonous acute appendicitis, much less often - perforation of duodenal ulcer and stomach, rupture of the bladder and digestive organs (advanced tumor or injury), acute pancreatitis or purulent cholecystitis.
In most cases, it is diagnosed acute peritonitis, which is deadly for a person. Therefore, timely medical care is very important.
There are several main types of this disease:
- Depending on the localization, peritonitis can be diffuse, general or local. In the latter case, a small portion of the abdominal cavity is affected, with diffuse inflammation - a separate part of it, with a total - the entire cavity.
- By origin distinguish infectious and aseptic peritonitis.
- According to the type of pathogen, peritonitis of the abdominal cavity can be streptococcal and staphylococcal, caused by mixed flora or E. coli.
- Depending on the causes, there are such types of this disease: traumatic, postoperative, perforative, hematogenous, occurring during inflammatory and other pathological processes that can occur in the abdominal cavity.
- According to the source of origin, abdominal peritonitis can be appendicular or may result from the perforation of a stomach ulcer.
- The clinical course is subacute, acute and chronic. Experts also distinguish the fulminant form of the disease, which is accompanied by septic shock.
Yet peritonitis - what is it? How does it manifest itself? Let's deal with the symptoms of this disease. So, the reactive stage of peritonitis is accompanied by abdominal sensations, pains, the strength and location of which are associated with the reason for which the inflammation of the abdominal cavity was formed.
First of all, the pain sensations are located directly at the site of the inflammatory process,at the same time, it can be given to a zone above the clavicle or to the shoulder due to irritation in the diaphragm by purulent masses of nerve endings. After some time, the pain gradually spreads throughout the abdomen, loses its exact location and becomes passing. Due to the development in the nerve endings of the abdominal cavity paralysis at the terminal stage, the pain begins to manifest itself somewhat weaker.
Very often, peritonitis of the abdominal cavity is accompanied by nausea with vomiting of stomach contents. This process in the early stages of the development of this disease takes place at a reflex level. In later stages, vomiting is caused by paresis in the intestine, along with vomiting, bile and intestinal contents are excreted. As a result of pronounced endotoxemia, paralytic ileus of the intestine occurs, the symptoms of which are stool retention and non-passage of gas.
Already in the early stages of peritonitis, the appearance of the victim becomes characteristic - a performance of cold sweat, weakness, pallor of the skin, acrocyanosis, and also a suffering expression on the face. At the same time, the patient tries to take forced positions, which make it possible to ease the pain - as a rule, this is a supine position or on a side with pursed legs.Heartbeat becomes more frequent, breathing becomes shallow, body temperature rises.
At the terminal stage, there is a strong deterioration of the patient's condition: the facial features become acute, a state of euphoria is noted, confusion occurs, mucous surfaces and skin cover turn pale, acquiring a bluish or icteric tinge, the mucosa of the tongue dries out, and the tongue is covered with a dark bloom. In addition, there is bloating, the feeling of which is almost painless, while drying, there is silence.
Peritonitis - what is it? Why does it arise? Many are interested in the answers to these questions. Let's try to figure it out. A large number of microorganisms inhabit the intestines, but only the effects of some of them can cause peritonitis. This happens due to the fact that some die in the oxygen environment, in other words, they are strict anaerobes. Others are subject to controlled death, which is provided by the anti-infective ability of the abdominal cavity. Depending on the conditions that resulted in the disease, there are two of its main forms - non-hospital and hospital.
The severity and speed of development of the disease largely depend on the presence of provoking factors, the pathogenicity of microbes and the state of the body. The development of peritonitis has the following main points:
- Decreased pressure in the vessels and dehydration lead to shortness of breath and a strong heartbeat.
- Paresis of the intestine leads to impaired function of absorption, the body begins to lose a large amount of electrolytes and water.
- The massiveness of the lesion and the rate of development of the disease are directly dependent on the level of intoxication and the number of pathogenic bacteria.
- Together with intoxication, which was caused by microbes, autointoxication appears. In the blood, antibodies that attack the lipopolysaccharide wall of bacteria begin to secrete in response to the aggression of microorganisms. The compliment system comes into activity, a large number of active substances are released, their action is manifested by intoxication.
Peritonitis - what is it? Its initial symptoms are quite varied. They are directly related to the cause that caused the disease. That is why the initial signs may be so different.However, there are several successive stages, which were mentioned earlier, they are associated with the time of symptoms. Consider them in more detail.
This stage develops in the first 24 hours. There is severe pain, it is at this time, you can clearly determine the localization. If the cause of this disease was perforation of the internal organ, then this pain is characterized as a dagger. For example, an appendix rupture is described as pain arising in the right iliac region, and perforation of a gastric ulcer as a sharp severe pain in the epigastric region.
Gradually, pain begins to spread to the rest of the abdomen. It happens that after the appearance of pain ceases to be intense and no longer so worried. This is a manifestation of the symptom of imaginary well-being. The face of the patient becomes pale, sometimes acquires an earthy tint. At the moment of pain, the face is covered with sweat. Due to dehydration, the features are sharpened.
Intense pain forces the patient to take a comfortable position to relieve it. On examination, it can be found that the abdominal muscles are strained — a board-like abdomen.In addition, there is a symptom of Shchetkin-Blumberg - at the time of palpation, a sharp weaning from the surface of the abdomen of the hand causes severe pain. Also, viral peritonitis is accompanied by vomiting, after which there is no improvement. First comes the water, after bile. The body temperature rises, often there is a fever with chills. Due to dehydration, mucous membranes become dry, the patient is thirsty. The amount of urine excreted is also reduced.
This stage begins on the second or third day. The general condition of the patient worsens, while the symptoms of the disease are less pronounced. Microcirculation is impaired. This is manifested cyanotic fingers and toes, ear lobes, nose. The patient has a very pale look. As a result of severe dehydration, brain functions are impaired. Man is indifferent to what is happening, consciousness is depressed. Or vice versa - he is delirious and very excited. Feeling the abdomen does not lead to any reactions. Vomiting of bile continues if the case is neglected - intestinal contents. Little urine is excreted or it may not be present at all. The temperature reaches high numbers (up to 42 degrees).The pulse becomes filiform. Disturbed heartbeat and severe shortness of breath.
In another way it is called irreversible. If by the third day the patient's condition does not improve, then purulent peritonitis is irreversible and in most cases ends in death. The patient has a very serious condition. The most pronounced dehydration. Facial features while sharpened so that it becomes difficult to know a person. This type has long been called the face of Hippocrates: bluish tint, pallor, dark circles under the eyes, sunken sockets.
Palpation of the abdomen does not give objective data. The patient does not respond to feeling. Breathing is impaired, artificial support for lung health is needed. There is no pulse on the peripheral arteries. In such a situation requires resuscitation care, as well as intensive treatment.
Diagnosis and treatment
One of the stages of diagnosis is a blood test. Purulent peritonitis is diagnosed through urine, blood, X-ray and ultrasound examinations, as well as examination of the patient.
In the event of the slightest suspicion of the disease, urgent hospitalization is required.If you experience a sharp pain can not waste time. It is strictly forbidden to take painkillers and laxatives, consume water and food, put enemas, and also engage in self-treatment. While waiting for qualified medical care, it is necessary to put the patient in a comfortable position, and something cold can be applied to the stomach.
As soon as a diagnosis is made, for example, viral peritonitis - it is treated by prompt emergency intervention. Its main purpose is the drainage of the abdominal cavity and the elimination of the source of inflammation (removal of an inflamed appendix, insertion of a perforated ulcer, etc.). In addition, a number of activities are carried out, their main goal is to reduce intoxication and fight against intestinal paresis.
Conservative treatment for all forms of this disease is not practiced, since any delay can provoke serious violations of the basic functions of the body, the spread of infection through the internal organs and subsequent death.
Peritonitis - surgery and preoperative preparation
In order for the surgery to be successful, competent preoperative preparation is required.Without fail, the patient is catheterized by the bladder, central and peripheral vein, premedication is used. The patient is injected on the operating table preparations "Tsirukal" (10-20 mg) and "Midazolam" (5 mg). It is strictly forbidden to enter "Atropine", as it can provoke the development of bradycardia. Introduced drugs that reduce the acidity of gastric juice (50 mg "Ranitidine" / "Famotidine" or 40 mg "Omeprazole").
During the operation, infusion therapy is carried out (about 1.5 liters of saline), if necessary, blood and plasma preparations are added. The artificial ventilation of the lungs is carried out, oxygen is supplied.
If there is more than 25 ml of contents in the patient's stomach, when he lies on the operating table, there is a risk of aspiration. In other words, getting into the lumen of the bronchial tree the contents of the stomach. Gastric juice can cause burns to the mucous membrane of the trachea and bronchi. Aspiration complications - pulmonary edema, respiratory failure, bronchospasm, multiple lung atelectasis. Aspiration with a small amount of gastric juice can provoke aspiration pneumonia.In this regard, in anesthesiology practice, anticholinergics and ganglioblokaty - drugs that reduce the tone of the lower esophageal sphincter are not used.
Antibacterial therapy is carried out by combining antibiotics that act simultaneously on gram-minus and gram-plus bacteria. In case of non-hospital disease, intravenous administration of Metronidazole and Cefotaxime. Intra-hospital - Metronidazole and Cefepime. If intestinal peritonitis develops in a hospital as a result of ongoing antibiotic therapy, carbapenems are used.
When peritonitis can not do without antibiotic therapy. After surgery, problems may arise related to the development of purulent deposits, severe pain, and impaired bowel function.
After peritonitis the following is necessary:
- Patient monitoring is an hourly assessment of heart rate, respiration, central venous pressure, diuresis, drainage discharge.
- Infusion therapy is carried out with crystalloid and colloid solutions.
- Infusion media for warming patients warm up to body temperature.
- For 72 hours, artificial respiration continues to provide tissues and organs with oxygen.
- A glucose solution is injected through a nasogastric tube.
- Prevention of pain.
If the patient has been diagnosed with peritonitis, after the operation he should be under close medical supervision. At this stage, narcotic analgesics are used in conjunction with anti-inflammatory nonsteroidal drugs. Used Ketorolac, Morphine, Fentanyl.
A very dangerous disease is peritonitis. Its consequences may be irreversible, therefore, it’s not worthwhile to place hope in the means of traditional medicine. However, in its arsenal there are reliable methods with which you can alleviate the condition of a person before providing qualified medical care.
- Thirst is one of the symptoms, while it is strictly forbidden to feed and water the patient. To quench your thirst, you can give the patient ice, while you can not allow him to swallow melt water.
- On the stomach of the patient should also put some ice, the main thing - that he did not press. The rubber bladder is filled with ice and suspended above the belly so that it touches it lightly.
- If there is no ice, you can make a compress on the stomach - vegetable oil and refined turpentine dismount in a ratio of 2: 1.
If a person can suffer pain, it is advisable not to take any measures to relieve his condition. This can lead to a blurring of the clinical picture, which will prevent the specialist from making the correct diagnosis.
To prevent dangerous inflammation of the abdominal cavity, it is necessary to be attentive to your health, to make early diagnostics, to treat diseases of the internal organs in time.
It consists in communicating to people information about the main symptoms of this disease. It is important that everyone knows that at the slightest suspicion of peritonitis, it is necessary to immediately call the ambulance team. It is in the timely treatment is the prevention of this disease.