Peritonitis is considered one of the oldest problems facing surgery, and at the same time it has not lost its relevance to this day.Peritonitis is an inflammation of the serous membrane covering the internal organs and the abdominal cavity (peritoneum). This condition is accompanied by a disruption in the functioning of internal organs and systems and symptoms of general intoxication of the body. Often, peritonitis occurs as a complication of other serious diseases, such as: ulcerative ulcer colitis, acute pancreatitis, appendicitis, liver disease, dysentery, gastric ulcer perforation or 12-finger guts.
By and large,cause of peritonitis is one- ingestion of foreign matter (pancreatic enzyme, bile) or pathogenic (opportunistic) microorganisms into the abdominal cavity. This "unauthorized" penetration also has its own causes, the main ones of which are inflammatory lesions with subsequent purulent melting of the abdominal cavity organs and trauma of the abdominal cavity organs (including
If speak aboutThe microorganisms that most often cause peritonitis, here they are by name: staphylococcus, streptococcus, E. coli, Pseudomonas aeruginosa, pneumococcus, gonococcus, mycobacterium tuberculosis.
Infectious peritonitisoften is a consequence of acute phlegmonous appendicitis, less often - perforation of stomach ulcers and 12 duodenal ulcer, acute purulent cholecystitis, acute pancreatitis, digestive and bladder ruptures (injuries or neglected tumor).
From the previous chapters we can already conclude that there is an infectious, perforated, traumatic and postoperative peritonitis. This classification of peritonitis, depending on the etiology. But there are other ways to classify this disease. For example, based on the nature of the inflammatory exudate, you can identify serous, hemorrhagic, purulent, fibrinous and gangrenous peritonitis. By the degree of diffusion - local and diffuse (diffuse) peritonitis.
The initial phase of peritonitis"Merges" with that of the underlying disease.The first symptom of peritonitis- Increased pain, which affects the entire area of the abdomen with a point of the highest morbidity in the place of the primary focus. The tonus of the abdominal muscles increases, and some compare the hardness of the muscles in this period with the washing board in a figurative way. Another onevivid symptom of peritonitis, is called the symptom of Shchetkin-Blumberg: if you palpate the abdomen quickly pull your arm, then there is a sharp soreness. With peritonitis, the patient instinctively tries to lie on his side and press his knees to the stomach (the so-called embryo posture), when trying to move the pain intensifies. The patient weakens, the speech becomes vague. The temperature rises.
The initial stage should betoxic. "Watershed" between these two stages is very well marked: at a toxic stage the patient becomes better, the pain calms down, the stomach relaxes, there are signs of euphoria, or, on the contrary, retardation. The face pales, at first nausea and vomiting begin. Because of the loss of fluid, urination decreases, in the mouth it dries up, but because of vomiting it becomes impossible to make up for lack of liquid. The intestine seems to freeze, without showing any signs of peristalsis. Mortality at this stage is 1 to 5.
The last stage -terminal, on which the defenses of the body are completely depleted. The patient becomes no longer absolutely sane, falls into prostration, does not react to external stimuli, the so-called intoxication disorder of the psyche occurs. In vomiting there is putrefactive contents of the intestine. The pulse rate increases, there is shortness of breath, body temperature decreases. Mortality at the terminal stage is close to 100%.
The severity of the symptoms of peritonitis makes it possible to diagnose it with a high degree of certainty already while examining the patient. As a "control shot a blood test is performed in which there is a purulent-toxic shift of the leukocyte formula. X-ray and ultrasound are also used.It is vital to identify peritonitis in the initial stage, since, this disease requires urgent treatment.
It is possible to treat peritonitis only surgically. And procrastination can lead to a fatal outcome, with a very high probability.
When surgical treatment, first of all, begin with disinfection of the main infectious focus and abdominal cavity. To this end, use isotonic sodium chloride solution, or 5% solution of novocaine in combination with antibacterial agents and antiseptics (with the exception of furatsilina). Then, the abdominal cavity is drained; form ways for the outflow of inflammatory exudate by means of drains made of silicone rubber. Drainage can remain in the focus of inflammation up to 2 weeks.
Sometimes in the terminal stage of peritonitis, the so-called peritoneal lavage is used. This flowing washing of the focus of inflammation - the abdominal cavity - solutions of antiseptics and antibiotics.
Recently, the method of planned relaparotomy - repeated laparotomy in postoperative period, which is performed a day after the operation and is completed by washing the abdominal cavity with the installation drainage. In the future, relaparotomy is carried out every 2 days, based on the patient's condition and the amount of exudate separated by drainage.
Over the past 15 years, the methods of extracorporeal detoxification (hyperbaric oxygenation, ultraviolet irradiation of blood, plasmapheresis, hemosorption) have gained popularity.
Prevention as such with peritonitis is not present. The only thing, if it can be called prevention, of course, is to once again mention the importance of early hospitalization and emergency treatment of patients with peritonitis.