Signs of peritonitis: the main symptoms in acute and chronic inflammation. Symptoms and treatment of peritonitis Peritonitis causes

Usually, peritonitis is a complication of any diseases and injuries of the abdomen, therefore, at the beginning of the development of the disease, the symptoms of the underlying disease come to the fore (against which peritonitis has developed).

Subsequently, with the progression of the process, the symptoms of peritonitis itself dominate in the clinical picture.

• Intense abdominal pains, often without a clear localization (location), which intensify with movement, coughing, sneezing. At the very beginning of the disease, pain can appear from the side of the affected organ (for example, with appendicitis (inflammation of the appendix of the cecum - appendix) - on the right), and then spread throughout the abdomen (diffuse pain). In the absence of treatment, pain may generally subside or disappear, which is an unfavorable prognostic sign and a consequence of necrosis (necrosis) of the nerve endings of the peritoneum.
• Nausea, vomiting (at the beginning of the disease, the contents of the stomach, later - with an admixture of bile and feces ("fecal" vomiting)). Vomiting does not bring relief to the patient, it can be very profuse and lead to dehydration (dehydration).
• Flatulence (bloating).
• Lack of intestinal peristalsis (motor activity).
• The characteristic posture of the patient is with legs bent at the knees and brought up to the stomach ("embryo posture"). This is due to the fact that in this position, the tension of the abdominal wall decreases and, therefore, the intensity of pain decreases somewhat.
• Pallor (marbling) of the skin.
• Dry skin and lips.
• An increase in body temperature to 39 ° C or more. Sometimes the body temperature remains normal or even decreases.
• Tachycardia (increased heart rate) up to 100-120 beats per minute.
• Muting heart sounds.
• Decrease in blood pressure.
• The patient worries, cries out in pain, writhes, he has a feeling of fear.

With the progression of the disease, convulsions, loss of consciousness, coma may appear (a serious condition associated with depression of the central nervous system, leading to loss of consciousness and dysfunction of vital organs).

Causes

• Most frequent cause peritonitis is a perforation (rupture) of an organ and the release of its contents into the abdominal cavity, due to which a chemical develops (for example, when a stomach ulcer is perforated (ruptured), aggressive gastric contents enter the abdominal cavity) or an infectious lesion of the peritoneal sheets (for example, during perforation appendix - appendix). Perforation can develop due to:
  • perforation (rupture) of the appendix (it is a complication of acute appendicitis (inflammation of the appendix of the intestine - the appendix));
  • perforation of a stomach ulcer or 12 duodenal ulcer (with peptic ulcer (the formation of ulcers (wall defects) in the stomach and / or intestines));
  • rupture of the intestinal wall by a swallowed foreign body (for example, parts of toys);
  • perforation of the intestinal diverticulum (protrusion of the wall of a hollow organ);
  • perforation of a malignant tumor.

• Infectious and inflammatory peritonitis:
  • acute appendicitis (inflammation of the appendix of the cecum - the appendix);
  • cholecystitis (inflammation of the gallbladder);
  • pancreatitis (inflammation of the pancreas).

• Postoperative peritonitis:
  • infection (infection) of the peritoneum during surgery;
  • trauma to the peritoneum during rough drying with gauze swabs;
  • treatment of the peritoneum with aggressive chemicals (iodine, alcohol) during the operation.
• Traumatic - after injury, abdominal trauma.

Diagnostics

• Analysis of complaints (complaints of severe abdominal pain, fever, vomiting, nausea) and anamnesis of the disease (when (how long ago) the symptoms of the disease appeared, against the background of which, whether any treatment, including surgery, was carried out earlier, notes whether the patient has a change in the intensity of pain (increase, decrease), a change in the nature of vomiting, etc.).
• Analysis of the anamnesis of life (whether the patient had any diseases of the abdominal cavity and small pelvis, malignant tumors, etc.).
• Physical examination. The condition is usually severe. The "embryo posture" is very characteristic - with legs bent at the knees and brought into the stomach, any change in body position leads to increased pain. On palpation (feeling) of the abdomen, there is an increase in pain. During the examination, the doctor pays attention to specific symptoms that may indicate inflammation of the peritoneum.
• Body temperature measurement. An increase in body temperature indicates the progression of the disease, the serious condition of the patient.
• Measurement of blood pressure. A decrease in blood pressure indicates a worsening of the patient's condition.
• Dynamic (hourly) observation of the patient. The doctor assesses the patient's condition, whether the clinical symptoms (abdominal pain, nausea, vomiting, etc.) of the disease are increasing, etc.
• Laboratory research methods.
  • A general blood test (to detect possible anemia ("anemia", a decrease in the content of erythrocytes (red blood cells) and hemoglobin (oxygen-carrying protein)), usually there are signs of an inflammatory process (increased ESR, leukocytes (white blood cells)).
  • General urine analysis in case of suspected infection.
  • Culture of blood, urine - carried out to detect infection.
  • Biochemical blood test - determination of liver enzymes (special proteins involved in chemical reactions in the body): aspartate aminotransferase (AST), alanine aminotransferase (ALT)), total protein and protein fractions, ionograms (potassium, calcium, sodium), sugar, indicators of renal function (creatinine, urea), etc.
• Instrumental research methods.
  • Ultrasound (ultrasound), magnetic resonance imaging (MRI), or computed tomography (CT) to detect abnormal abnormalities in the abdominal organs.
  • An electrocardiogram (ECG) is a method of recording electrical fields that are generated during the heart.
  • Plain X-ray of the abdominal organs to identify a possible source of peritonitis ("primary focus").
  • Ultrasound of the pelvic organs with suspected inflammation of the pelvic peritoneum (pelvioperitonitis).
  • Laparoscopy is an endoscopic examination and surgical intervention on the abdominal and pelvic organs. The procedure is carried out through small holes in the anterior abdominal wall, through which an apparatus - an endoscope - is inserted to examine the abdominal organs and an instrument with which the operation is performed, if necessary.
  • Laparocentesis (puncture of the anterior abdominal wall in order to obtain exudate (abdominal fluid)).

Peritonitis treatment

Treatment of peritonitis must be carried out in a hospital. Self-administration of painkillers, heating pads, hot baths is not allowed, as these measures can "erase" the clinical picture of the disease and significantly complicate early diagnosis and treatment.

Peritonitis is an indication for operative (surgical) treatment.
The purpose of the operation is to detect and eliminate the source of peritonitis (removal of the appendix (appendix of the cecum), suturing of the stomach, intestines, etc.).

After detecting (and removing) the source of peritonitis, the abdominal cavity is repeatedly washed with antiseptic solutions (to eliminate the infection) and provide drainage of the abdominal cavity and small pelvis (ensuring the outflow of the contents of the abdominal cavity).
In addition, through the drainage tubes installed during the operation, the abdominal cavity is washed with antiseptic solutions.

Before and after the operation, conservative therapy is carried out, which consists in the appointment of:

• antibiotic therapy (to treat infection);
• gastric lavage;
• pain relief (elimination of pain syndrome);
• infusion therapy (to treat dehydration):
• correction of the impaired function of internal organs (if necessary - heart, kidneys, liver, etc.);
• drugs that bind and remove toxic (harmful) substances from the body (sorbents);
• vitamin K preparations with the development of bleeding;
• multivitamin preparations (vitamin complex);
• antiemetic drugs for nausea and vomiting;
• antipyretic drugs;
• sedative (sedative) drugs;
• anticonvulsants;
• extracorporeal detoxification to remove toxic substances circulating in the bloodstream (plasmapheresis, hemosorption).

Complications and consequences

• Abdominal abscess (development of an abscess - a limited inflammatory process).
• Hepatitis (inflammation of the liver).
• Encephalopathy (damage to the nervous system by toxic (harmful, poisonous) products that are absorbed into the bloodstream).
• Multiple organ failure (dysfunction of many organs - kidneys, liver, heart, etc.).
• Swelling of the brain.
• Pneumonia (pneumonia)
• Dehydration (dehydration of the body).
• Paresis (lack of peristalsis - motor activity) of the intestine.
• Adventure (median wound divergence).
• Intestinal fistulas (the formation of holes in the intestinal wall that connect to the surface of the body (external fistula) or some organ (internal fistula)).

Prevention of peritonitis

Prevention consists in the timely treatment of diseases (for example, perforation of a stomach or duodenal ulcer (with peptic ulcer (formation of ulcers (wall defects) in the stomach and / or intestines)), acute appendicitis (inflammation of the appendix of the cecum - appendix)), which led to the development of peritonitis.

Signs of peritonitis always proceed with the most acute symptoms, and in the acute form, pathology can cause serious risks to human health and life. The disease is not classified according to gender and age, and the appearance of the disease is often caused by various predisposing factors. Peritonitis is an area of \u200b\u200bresearch in gastroenterology and practical surgery.

Anatomical features of the peritoneum

Features of pathology

Peritonitis appears to be a common (diffuse, diffuse) or local inflammatory process of the serous layer of the peritoneum. Signs of peritonitis are characterized by severe condition, increased muscle tone, problem stools, delayed gas release, high fever, symptoms of severe intoxication. In the initial diagnosis of an acute condition, there is often a burdened gastroenterological history, acute abdomen syndrome, and other pathological conditions of some organs or systems. Treatment of peritonitis is always urgent surgical, which is due not only to the danger of the inflammatory process, but also to the anatomical structure of the peritoneal space.

The peritoneum (from Latin "peritoneum") is anatomically formed by serous layers (otherwise, visceral and parietal sheets), passing into each other, forming a kind of protection for the organs and walls of the peritoneum. The abdominal space is a continuously functioning semi-permeable membrane, which is based on numerous functions:

• resorptive (absorption of dead tissue, metabolic products, exudate);
• exudative (separation of serous organic fluid);
• barrier (protection of the epigastric organs).

The main protective property of the peritoneum is the ability to delimit the inflammatory process in the abdominal region, for some time to prevent its spread throughout the body and adjacent organs. The possibility is due to the presence of adhesions, fibrous tissue, cellular and hormonal mechanisms in the structure of the peritoneum.

Clinicians explain the high mortality rate from peritonitis by the duration of the pathological process, an increase in the number of elderly patients, the difficulty and specificity of differential diagnosis, inadequate therapy and the severity of complications. According to statistics, peritonitis is recorded in 20% of patients with acute abdomen syndrome, in almost 43% of cases it is the cause of tissue excision of almost all organs of the epigastric space. The success of the treatment of peritonitis does not reduce the mortality rate of patients due to the peculiarities of the clinical history, the severity of the pathology, and the characteristics of the organism. Peritonitis of the abdominal cavity after surgery requires special attention due to the risks of continuing the inflammatory process.

Peritonitis symptoms

The main difficulty in the initial diagnosis of peritonitis lies in the similarity of the symptoms of the manifestation of peritonitis and the disease provoking it. External manifestations of pathology may indicate an exacerbation of concomitant diseases of the gastrointestinal tract, which can be mistakenly perceived by both patients and doctors. This is especially true in chronic forms of gastroenterological diseases during periods of exacerbation. Signs of the development of peritonitis in acute condition and chronicity of pathology are different.

Forced position of the body with peritonitis

General stages of development

The clinical picture of peritonitis completely depends on the duration of the course of the disease, on the nature of the inflammatory process, on the patient's age and history of his illness. In surgical and gastroenterological practice, stages of peritonitis are distinguished.

First stage

The first stage (reactive stage) develops rapidly and lasts about a day. Symptoms are local in nature, the general condition of the patient is severe, and there is an expression of obvious suffering on the face. The main features include:

• severe soreness;
• forced position of the patient's body;
• pallor or cyanosis of the skin;
• sweating;
• indomitable vomiting;
• signs of intoxication;
• increased body temperature.

Soreness is permanent, often localized in the area of \u200b\u200binflammation, but there is a generalization of the pain focus. Sometimes patients experience imaginary well-being due to a decrease in the intensity of pain, but the next attacks of pain occur after a couple of hours. On palpation, the soreness increases immediately after the hand is removed from the peritoneum (Shchetkin-Blumberg symptom). The patient tries in every possible way to reduce suffering by adopting a forced body position. The usual poses are on the side or on the back with the legs brought up to the stomach.

Stage two

The second stage (toxic stage) begins 72 hours after the first signs of peritonitis. Local signs are gradually erased or completely disappear. The patient's facial features are noticeably sharpened, the pallor of the skin becomes pronounced, the nail plates turn blue. The limbs become cool or even cold. Patients are confused, show complete indifference to what is happening (less often, excessive emotional arousal occurs). Arousal is usually common in young children, for whom screaming is the only way to draw attention to pain and suffering. There is an episodic loss of consciousness. The abdomen is painless on palpation. Thirst and dry mouth become excruciating, and constant deep vomiting does not bring any relief. The vomit takes on a dark brown color with an admixture of blood, and has an unpleasant smell of decay. Retention of urine is often observed, up to the complete loss of urinary function. The temperature reaches 42 degrees, the pulse is barely palpable.

Third stage

The terminal stage is irreversible. The countdown begins 3-4 days after the onset of the disease. In some cases, the third stage of peritonitis almost always ends with the death of the patient. The condition by the nature of the disease is especially severe, the external manifestations of peritonitis are the same for all patients:

• pale skin with a bluish tinge;
• sharp facial features;
• lack of pain;
• lack of muscle tension in the peritoneum;
• respiratory failure, up to and including its absence;
• lack of pulse and blood pressure.

In the terminal stage of peritonitis, patients are in intensive care boxes, connected to artificial life support devices. At the last stage, pronounced multiple organ failure develops with dysfunction of almost all organs and systems.

Important! Acute diffuse peritonitis develops precisely at the second stage of the development of pathology, when intoxication becomes more pronounced. The liver ceases to perform its detoxification function, irreversible changes occur in the renal structures.

Peritoneal dialysis or hemodialysis is ineffective. In laboratory blood tests, characteristic signs of diffuse peritonitis are revealed (the rate of erythrocyte sedimentation increases, pronounced leukocytosis, and more).

Signs of chronic peritonitis

Chronic peritonitis can occur as a result of systematic exposure to the structures of the abdominal cavity of infectious agents or in the form of a residual complication after an acute diffuse process. Chronization of peritonitis often occurs due to tuberculosis of organs or body systems. The signs of chronic peritonitis are often blurred, it is impossible to determine the exact time of the onset of an exacerbation. Usually the period of exacerbation is determined by the onset of intoxication. Typical symptoms include:

• fast fatiguability;
• emotional instability;
• deterioration in general health;
• weight loss;
• persistent increase in body temperature;
• upset stool (diarrhea along with constipation);
• severe swelling, soreness.

Note! The classic symptom is intestinal obstruction and severe problems with stool. With the chronicity of peritonitis, it is important to carry out high-quality treatment of provoking conditions, since when only purulent exudate is removed, the pathology will progress. As the number of episodes increases, not only the prognosis for the quality of life worsens, but also its threat.

Signs of postoperative peritonitis

Postoperative peritoneal inflammation is a common complication after epigastric surgery. The main causes of occurrence are the following:

• failure of suture components;
• acute pancreatitis:
• necrosis of gastric tissues;
• perforation of ulcerative foci;
• infection during the operation;
• insufficient antiseptic treatment after surgery.

Extensive localization of pain

Peritonitis after surgery occurs quite often, since with diffuse inflammation, it is problematic to achieve absolute removal of purulent exudate from all parts of the abdominal space. The clinical picture of postoperative peritonitis is not separated into a separate characteristic scheme, which significantly complicates the diagnosis of pathology. Against the background of the surgery for peritonitis, it is even more difficult to identify the postoperative form from the ongoing inflammation. Additional problems in accurate diagnosis are added by painkillers, hormones, antibiotics, and the patient is already in serious condition. With a burdened gastroenterological history of the patient, in the presence of concomitant pathologies of organs or systems, it is important to approach any changes in the body with particular care.

Important! The outcome of complications depends entirely on the degree of patient care in the postoperative period, dynamic observation, and regular collection of tests to exclude an increase in endogenous intoxication.

Common symptoms of peritonitis

A reliable sign of peritonitis is general malaise and symptoms of intoxication (vomiting, nausea, diarrhea, or constipation). A special point in the diagnosis of peritonitis are specific general signs that characterize changes in the central nervous system and the general condition of the patient. Common features include:

• chills, persistent temperature (high or low grade);
• weakness, indifference, apathy;
• jumps in blood pressure (up to 140 and above mm Hg);
• sharpening of facial features;
• pallor and moisture of the skin;
• sleep disorders;
• soreness of varying intensity.

The common symptoms in children and adults are almost the same. The main difference is the increased compensatory resource of the child's body, therefore, even with acute peritonitis in children, the first stage of the disease can be significantly delayed. Elderly people, people with reduced body weight, with autoimmune diseases are more difficult to tolerate peritonitis. Even after adequate and timely treatment, they have serious complications.

Complications of pathology

Acute localized or diffuse peritonitis almost always leaves its mark on the life of every patient. This is expressed in complications of varying severity. The development of complications directly depends on the nature of the pathology, the neglect of the inflammatory process, on the age and clinical history of the patient. Among the complications of peritonitis are:

• abscess of the abdominal cavity with a local abscess;
• encephalopathy of the hepatic structures;
• dehydration of the body;
• intestinal paresis;
• extensive sepsis or septic shock;
• pneumonia;
• non-infectious hepatitis;
• gangrenous changes in the intestinal loops.

Important! A reliable method for the prevention of peritonitis consists in systematic medical monitoring of the state of the body, especially in the presence of various pathologies of organs or systems. Often, it is the existing diseases that become the trigger for the development of inflammation of the peritoneal tissues.

What it is?

Peritonitis is an inflammation of the peritoneum. The victim has a stomach ache, stool and gas are delayed, vomiting and tension of the abdominal muscles appear. He is in a difficult physiological state, suffers from an excess of heat in the body, which leads to a rapid rise in temperature.

Peritonitis of the abdominal cavity is treated only with surgery.

The peritoneum is a serous membrane that protects the digestive tract. The peritoneum is parietal and visceral.

The first type of shell protects the inner wall of the abdomen. Visceral covers the surface of the organs inside the parietal leaf.

Causes of peritonitis

Infectious peritonitis is caused by bacteria and germs. The following microorganisms provoke the disease:

• fusobacterium;
• enterobacter;
• proteus;
• streptococcus;
• eubacteria;
• peptococcus;
• pseudomonas aeruginosa;

In most cases, viral peritonitis is caused by E. coli and staphylococci.

In addition to microbes, there are other causes of the onset of the disease:

• inflammation processes occurring in the peritoneum ( , );
• a defect in the digestive system;
• the appearance of through holes in the abdominal organs (or stomach during an ulcer, appendix, part of the large intestine);
• surgical interventions in the abdominal organs;
• inflammation of the phlegmon of the abdominal cover of the abdomen, the processes of decay in the retroperitoneal tissue.

Symptoms

There are 3 stages of the disease. Therefore, everyone has their own symptoms. The main signs of peritonitis:

• increased temperature and blood pressure;
• nausea with vomiting;
• dry mouth;
• heart palpitations.

Peritonitis in children has the same signs as symptoms in adults

Symptoms of the first stage of the disease

This is a long-term abdominal pain that worsens with changes in body position. The patient lies and tries not to make movements. Symptom Shchetkin-Blumberg allows you to detect this ailment.

It is necessary to slowly press on the abdominal wall, hold the hand for 3-6 seconds and remove it sharply. The emergence of severe pain, it says that the person suffers from peritonitis.

Also, the disease can be determined using Mendel's symptom. You need to tap all over the abdomen. If the pain gets worse, the person is sick. This method establishes the place of pathology.

Symptoms of the second stage of peritonitis

The pain in her abdomen and the tension in her muscles subside. Stool retention, frequent vomiting with an unpleasant odor begins to appear.

The heartbeat also accelerates (more than 115 beats per minute), the pressure decreases, and the body temperature rises. Intoxication symptoms occur.

Symptoms of the third stage of the disease

Due to lack of water, the patient's skin becomes pale, facial features become sharp. There is a fast heartbeat, low blood pressure, incomplete breathing, and bloating.

There is no peristalsis - wave-like contractions of the walls of the digestive tract, leading to the movement of food.

The patient's psychological state changes dramatically due to intoxication (poisoning): from adynamia (loss of strength) to euphoria (state of bliss). In rare cases, delirium appears, confusion of consciousness.

Types and stages of peritonitis

Acute peritonitis is classified into three stages:

• First stage intestinal peritonitis (reactive, duration - half a day). The body begins to fight the infection that has entered the peritoneum. This leads to localized inflammation in the form of edema, hyperemia (overflow of blood vessels in the body area), accumulation of exudate.

Exudate is a liquid that is secreted in the tissues of organs due to blood vessels during the inflammatory process. At first it is serous, later, due to an increase in the number of bacteria and leukocytes, it becomes purulent.

The peritoneum limits the problem area from healthy parts of the body. Therefore, this stage is characterized by the formation of adhesions in the peritoneum and nearby organs.

Swelling and infiltration may appear near the organs located. The latter is the penetration into tissues of substances that are not their normal constituent parts.

• Stage II peritonitis (toxic, duration from 3 to 5 days). The body's immune response to inflammation is enhanced. Microorganisms, their waste products (endotoxins) and proteins (polypeptides, proteases) enter the bloodstream and the lymphatic system. Signs of stage 2 peritonitis: suppression of intestinal contractility, degeneration of the digestive organs, hemodynamic disorders (lowering blood pressure), blood clotting failure. Purulent peritonitis can lead to disruption of the cardiovascular system ( , , endocarditis).
• Intestinal peritonitis of the third stage (terminal, duration - 1-3 weeks). There is an abrupt change in body temperature, chills, frequent pulse, a decrease in pressure, pallor of the epidermal membranes (skin). There is also nausea accompanied by vomiting, rapid weight loss, acute abdominal pain, diarrhea. The work of making protein is getting worse. The amount of ammonium and glycol in the blood increases. The brain cells swell, the volume of the spinal cord increases.

Due to the onset of medicine, the following types of disease are distinguished:

• Idiopathic abdominal peritonitis. It appears due to the ingress of bacteria along with the outflow of lymph, blood or through the tubes of the uterus with enterocolitis , , tuberculosis of the genital organs. Another name is viral peritonitis.
• Secondary intestinal peritonitis. It occurs with injuries, inflammatory diseases of organs. Observed when:
  • appendicitis;
  • peptic ulcer of the stomach or duodenal ulcer;
  • disease "";
  • pancreatic necrosis (dysfunction of the pancreas);
  • (severe chronic disease of the gastrointestinal tract);
  • with inflammation of the gallbladder;
  • occlusion of mesenteric vessels (impaired blood circulation of the vessels feeding the mesentery);
  • (inflammation of the inner lining of the large intestine).

Secondary peritonitis is more common than primary peritonitis, which is detected in 2% of victims.

For a microbial reason, it happens:

• infectious peritonitis. It appears due to aggressive substances trapped in the abdominal cavity. They cause inflammation;
• viral peritonitis. It is provoked by inflammation caused by microorganisms.

Peritonitis resulting from trauma is divided into:

• arising from open or closed injuries that induce defects in the peritoneal organs;
• arising from surgical operations. They are accompanied by a violation of the position of the seams, the failure of the junction of the individual elements of the network and the accumulation of blood.

There are special types of peritonitis:

The composition of the substances accumulating in the abdominal cavity is distinguished:

• purulent (purulent peritonitis is characterized by a high rate of death);
• hemorrhagic (blood is mixed with exudate);
• serous (effusion consists of a liquid with a low concentration of protein elements);
• mixed (serous-fibrinous);
• fecal (appears with injuries of the abdominal cavity);
• bilious (bile flows into a vulnerable spot);
• fibrinous (fibrinogen fibers cover the peritoneum, forming adhesions).

According to the form of the lesion of the peritoneum, there are:

• unlimited. The area of \u200b\u200binflammation is diffuse, without precise boundaries;
• limited. In the problem area, an accumulation of pus appears in the organs and the densification of cells in the tissues of the body.

By the affected area it happens:

• Local. The damage is caused to one anatomical region of the abdominal cavity;
• Common. 2-5 zones are affected;
• General. Inflamed from 6 or more areas.

Peritonitis is acute and chronic. The acute form of the disease proceeds in three stages, described above. Chronic peritonitis occurs when , .

Peritonitis in children

Acute peritonitis is common in children. They are vulnerable to disease because their immunity is only beginning to adapt to the environment. Children find it more difficult to make a correct diagnosis because of the difficulty in describing the symptoms. Acute peritonitis is life-threatening for the child.

Peritonitis in adults

Infectious peritonitis of adults practically does not bother. They are more affected by chronic or purulent peritonitis. It is more difficult to detect due to the lack of significant symptoms.

First, the body deals with microbes. Later, there is weight loss, an increase in body temperature up to 37.5 ° C, drowsiness, heaviness.

Diagnostics

The initial stage includes examination of the patient and identification of symptoms:

• Medel;
• Bernstein;
• Voskresensky;
• Shchetkin-Blumberg.

The patient is undergoing research:

• Radiography. A sickle symptom is established under the diaphragm. With intestinal obstruction, the Kloyber bowl is determined.
• Blood analysis. An increase in the number of leukocytes is also found;
• Ultrasound of the peritoneum.

In rare cases, laparoscopy is prescribed.

Treatment

After detecting peritonitis, the patient is determined to have a surgical operation. It aims to address the root cause. It is impossible to cure the disease in other ways.

Surgery

The patient is hospitalized and carried out preoperative measures aimed at treating peritonitis:

• relieve pain shock - administer anesthesia;
• bring pressure back to normal due to the introduction of food, liquids, medicines.

It also helps to normalize the amount of water in the human body and eradicate infections.

During surgical intervention, a laparotomy is performed, treating the entire contents with a special antibacterial agent. The abdominal wall is cut in order to identify through holes in the stomach or intestines. The perforations are sutured, the pus, along with a part of the hollow organs, is cut off and removed.

During an emergency operation, when peritonitis progresses in the last stages, the surgeon eliminates exclusively the cause of the disease. The remaining activities are scheduled for the next term, because purulent inflammation prevents their implementation.

Decompression of the small intestine is performed by nasointestinal intubation. This is the introduction of the hose through the mouth or nostril cavity. It is also used to evacuate intestinal contents and implement artificial intake of nutrients.

Drainage - removal of fluid with rubber tubes - the large intestine is carried out to eliminate peritonitis through the anus. The activity includes the elimination of exudate and the introduction of antimicrobial solutions to destroy harmful microorganisms.

Treatment after surgery

Peritonitis after surgery requires special treatment. It is the intake of drugs that destroy the pathogenic microflora, restore the activity of the digestive tract and normalize immunity.

Also, the patient is credited with a diet that he must adhere to for a week. Peritonitis in children is treated in the same way as in adults.

Drug treatment

The following types of medications are prescribed:

• antibiotics. Penicillin-Teva, benzylpenicillin, ceftriaxone, gentamicin and others;
• diuretics, the active ingredients of which are Indapamide (trade name - "Arifon"), Spironolactone ("Veroshpiron"), Torasemid ("Trigrim");
• funds aimed at removing toxic substances from the body. These include "Calcium gluconate", "Splenin", "Unitiol" and others;
• infusion solutions ("Gemodez", "Gelatinol", "Reopolyglyukin");
• blood products - "Albumin" (5% and 20% solutions), "protein", "fibrinogen";
• non-steroidal anti-inflammatory drugs - "Ketoprofen", "Arcoxia", "Indomethacin";
• drugs that prevent vomiting. Contain ondansetron ("Emeset"), domperidone ("Motilium");
• drugs aimed at preventing the development of intestinal paresis. These are "Neostigmine", "Physostigmine".

Also used:

• ultraviolet blood irradiation;
• plasmapheresis (cleaning and returning blood back to part of the circulatory system);
• intravenous laser blood irradiation;
• hemodialysis;
• cleansing the lymph from toxic substances;
• hyperbaric oxygenation (a method of using oxygen under high pressure).

Important! If you experience abdominal pain, you should never take pain relievers. This can lead to a decrease in symptoms. Then it will be more difficult for the doctor to recognize the disease.

Diet after surgery

The patient needs to take liquid in the proportion of 50-60 milliliters per kilogram of body weight per day.

After the normalization of the digestive system, the introduction of vitamin mixtures is prescribed using a probe through the mouth or nose. Upon recovery, dietary meals are prescribed for a long time.

The composition of the diet is as follows:

• low-fat broth;
• vegetable puree;
• fruits, jelly, berry compotes.

Gradually increase the calorie content by adding boiled and steamed meat, chicken eggs, dairy products to the diet.

Do not eat:

• fatty meats;
• smoked;
• chocolate and confectionery;
• spices;
• coffee and carbonated drinks;
• legumes.

Complementary and alternative home treatments

Before the arrival of specialists, you need to provide first aid using folk remedies. Otherwise, the risk of death increases.

• Ice. It is necessary to wrap ice in a cloth, lightly apply it on the stomach. This will reduce the pain.
• Turpentine. It is necessary to prepare a compress from refined turpentine and vegetable oil in a ratio of 1 to 2, respectively. Apply to the belly.

Prevention

Purulent peritonitis can be avoided by observing the following rules:

• do not delay the treatment of diseases that can lead to serious complications (appendicitis, etc.);
• get 50% -60% of all energy per day from fruits, vegetables and other foods rich in vitamins and chemical elements;
• give up unhealthy foods (fast food, sugary carbonated drinks, etc.);
• avoid hypothermia of the body;
• to avoid stress;
• do not take medicine without consulting a doctor;
• get enough sleep, do not forget to rest after work;
• wash fruits, vegetables, berries and hands thoroughly before eating.

Forecast

30% of patients with peritonitis die, and with multiple organ failure, the lethal outcome is 90%. Peritonitis in children is even more dangerous due to their weak immune systems.

It all depends on the type, degree of the disease and on the timely access to an ambulance.

Treatment of peritonitis in the first hours can save 90% of the operated patients. After a day, this figure reaches 50%, after three - 10%.

Related Videos

Interesting

In the minds of patients and their relatives, this word often acquires a fatal meaning. At the same time, there are forms of local peritonitis in response to inflammatory diseases or injuries of the abdominal organs, when complete cure of patients is achieved in a timely and adequately performed operation.

Causes of the disease

Inflammation of the peritoneum can occur as a result of bacterial infection or exposure to aggressive non-infectious agents: blood, bile, gastric juice, pancreatic juice, urine.

Most often, peritonitis is the result of perforation or destruction of the abdominal organs (with appendicitis, rupture of the colon diverticulum, intestinal obstruction, acute, etc.), which leads to the ingress of bacteria-containing feces or pus into the abdominal cavity.

A more rare cause is penetrating wounds of the abdominal cavity, when the infection is brought in either from the outside or with the contents of damaged hollow organs. In some cases, the cause of peritonitis is the hematogenous spread of infection from foci in organs and tissues.

Peritonitis symptoms

The clinical picture of peritonitis, as a rule, develops sharply and quickly. In the absence of treatment, from the onset of the inflammatory process to the death of the patient, it often takes only 2-3 days.

Symptoms of peritonitis include sharp, constantly increasing with a change in position, nausea, vomiting, a rapid rise in temperature up to high numbers, accompanied by chills and sweating; loss of appetite. Examination reveals a hard, painful abdomen, rapid pulse, and sometimes a drop in blood pressure.

In the blood, the number of leukocytes of cells that fight infection increases.

With the abdominal cavity, fluid-filled, stretched bowel loops are usually visible, and with the patient's vertical position, the accumulation of air under the diaphragm, which is a specific diagnostic sign of perforation of hollow organs.

Diagnosis of peritonitis

In the admission department of the hospital, after examining the surgeon, the patient undergoes an ultrasound of the abdominal cavity, an overview X-ray of the abdominal cavity.

It is possible that diagnostic laparoscopy or laparotomy, as well as other studies, will be necessary to confirm the diagnosis.

If you or a loved one is in the hospital, you should remember that peritonitis is a life-threatening disease and refusal of medical intervention and diagnostic procedures can significantly worsen the prognosis.

What can you do

A patient experiencing sharp abdominal pains that cannot be stopped by antispasmodic drugs (, baralgin) should immediately consult a doctor, and not wait for their spontaneous weakening. Timely calling an ambulance in most cases is decisive in saving the patient.

How the doctor can help

The severity and rapid progression of the disease require an early diagnosis, hospitalization and treatment in the first 12 hours from the onset of the disease. Therapeutic tactics for peritonitis depends on the cause of its occurrence. As a rule, in such a situation, surgical intervention and massive antibiotic therapy are necessary. Most likely, in the postoperative period, the patient will need intensive therapy in the intensive care unit.

Peritonitis is an inflammation of the abdominal cavity. It manifests itself as a complication after pathologies - the ingress of microbes into the body through the blood or lymph, which is called primary peritonitis. Secondary peritonitis includes damage and inflammation of the digestive system. All this leads to the accumulation of fluid in the peritoneum, intoxication of the body and deterioration of health. In this article, we will consider what symptoms in adults appear during illness.

The disease is characterized by severe tension and soreness of the abdominal muscles. There are three stages in which the number of symptoms and the level of pain may increase. General symptoms are added to local pains.

Normally, there is a small volume of fluid between the sheets of the abdominal cavity. The inflammation starts for one of the reasons:

• ingress of harmful microorganisms- Streptococcus, Pseudomonas aeruginosa or Escherichia coli, Klebsiella, Proteus, pneumococcus and others;
• perforation of the digestive system... With perforation in the organ, a through defect is formed, which leads to the ingress of various fluids into the peritoneum;
• accidental injury to internal organsduring a surgical operation;
• mechanical damage to the abdomenat home ;
• diseases organs of the digestive system- from salpingitis and appendicitis to cholecystitis;
• inflammation of the tissue behind the peritoneum and abdominal walls,having no connection with the insides. These are purulent processes, phlegmon and others.

Important. There is an increased risk of organ damage and subsequent inflammation during exacerbations and untimely treatment of the following diseases: ulcer in the duodenum or stomach, ulcerative colitis in the colon, reactive pancreatitis, intestinal obstruction, phlegmonous or gangrenous appendicitis, destructive bladder cholecystitis.

Classification

The disease is classified according to several criteria at once:

• by the type of pathogen;
• due to development;
• by prevalence;
• in form:
• by the type of exudate (fluid released during the disease).

The form

There are chronic and acute forms. In the first case, peritonitis manifests itself with syphilis or tuberculosis. In the second case, everything depends on the phase, which can be toxic, reactive and terminal.

1. Reactive. The term is the first 12-24 hours. It is characterized by a feeling of nausea, swelling of the abdomen and increased local pain in it, fever, vomiting.
2. Toxic. Term - 2-3 days after the first stage. Toxicosis and symptoms of general intoxication of the body appear. It is characterized by severe vomiting, dehydration, decreased blood pressure, increased heart rate up to 110-120 beats.
3. Terminal. Term - 3 days after the second stage. Strong intoxication of the body, serious condition of the patient. It is characterized by a decrease in pain due to the death of nerve endings, apathy, a weak pulse, and a very low blood pressure.

Prevalence

Distinguish between local, widespread and total. In the first case, the inflammation occurs in one anatomical part of the peritoneum, in the second - in two to five, and in the total - in six or more.

Reason for development

Depending on the reason for the inflammation, there are five types of peritonitis.

Table 1. Types of peritonitis

The sixth type is cryptogenic peritonitis, in which it is not possible to accurately determine the cause of the inflammation.

Type of pathogen

There are two categories - bacterial and aseptic. The first arises from the corresponding pathogens - aerobic and other harmful microorganisms. The second manifests itself when the contents of the gastrointestinal tract or digestive juice, bile, blood enter the cavity. After a few hours, the aseptic process flows into a bacterial one due to the development of pathologies in the microflora.

Exudate

Depending on the fluid that is released from the tissues, there are the following types of disease:

• fecal;
• purulent;
• bilious;
• serous;
• fibrinous;
• hemorrhagic.

There is also a mixed type that combines several categories at once.

Video - Intestinal peritonitis (inflammation of the peritoneum) purulent, fecal, serous

Symptoms

There are local and general symptoms. The first category is characterized by local abdominal pain and muscle tension. They intensify when pressed (palpation). Severe pains force the person to lie only in the embryo position: on the side with bent legs brought to the stomach.

Common symptoms are nausea, weakness, heart palpitations, fever up to 37-39 0, confusion and other disorders that do not occur in the abdomen.

Fact: in this case, the abdominal muscles are in constant tension, regardless of the stage.

Inflammation stages

Table 1. Stages of inflammation

Stage	Local symptoms	Common symptoms
The first	Continuous abdominal pain. If you try to change the position of the body, the pain intensifies.	Increased blood pressure, palpitations, nausea, vomiting, dry mucous membranes.
The second	Soreness and tension subside as intoxication begins.	Pronounced bloating, profuse vomiting, stool retention, heart palpitations, fever up to 38-39 degrees, lowering blood pressure.
Third	Local symptoms may be weak or completely absent due to a deterioration in the general condition of a person	Pronounced intoxication and dehydration. Dry mucous membranes, pallor of the skin, bloating, tachycardia and low blood pressure, frequent and shallow breathing, lack of peristalsis, severe vomiting of intestinal and stomach contents. Due to the serious condition, disorders of the nervous system appear - delirium, confusion, mood swings.

Complications and consequences

In case of late treatment or difficult cases (hospitalization 12 or more hours after the onset of symptoms) and after surgery, the following consequences are possible:

• paresis;
• hepatitis;
• swelling of the brain;
• pneumonia;
• occurrence;
• bleeding;
• dehydration;
• encephalopathy;
• intestinal fistulas;
• abscess of the peritoneum;
• pathology in the kidney area;
• intestinal obstruction;
• necrosis of intestinal tissue;
• multiple organ failure.

How do doctors diagnose the disease

With peritonitis, the following types of diagnostics are performed:

1. Analysis of complaints of a person and his lifestyle.
2. Physical examination and abdominal palpation. A characteristic feature is the desire to lie in the embryo position.
3. General urine analysis.
4. Measurement of temperature and blood pressure.
5. Ultrasound of the peritoneum to determine free fluid.
6. A clinical blood test to determine leukocytosis is a change in the cellular composition with an increase in the number of white blood cells.
7. Rectal and vaginal examination to determine severe pain in the rectum and vaginal fornix, respectively.
8. X-ray of the peritoneum to determine the darkening of the cavity against the background of fluid accumulation.
9. Puncture to examine the contents of the peritoneum.

If the doctor doubts the diagnosis, then he prescribes laparoscopy - a modern type of operation using a special device that makes small holes in the abdomen.

Important: a person's health and life depends on the stage of inflammation and the promptness of assistance. If the operation is not carried out on time, the inflammation will lead to death in just 4-6 days.

How the treatment proceeds

Surgical operation and a course of medication are required. The operation allows you to eliminate the causes of peritonitis and drain the peritoneum (remove the fluid that has accumulated inside). During the operation, doctors:

• conduct preparation - cleanse and wash the gastrointestinal tract, produce anesthesia;
• cut the front wall of the peritoneum;
• eliminate the source. It all depends on the cause of the inflammation. For example, doctors can remove the gallbladder, appendix, suture the walls of the organ, or resect an ulcer;
• wash the peritoneum with antiseptic agents;
• decompression of the intestines;
• a drainage system is introduced;
• suture the wound.

Important: in no case should you take painkillers without permission to stop the pain effect. This will reduce the severity of symptoms, making it difficult for the doctor to make a diagnosis.

Drug treatment

May include the use of one or immediately groups of funds:

Fact: the prevention of inflammation lies in the correct treatment and control of diseases of the digestive system, be it acute appendicitis, cholecystitis, stomach or duodenal ulcers, pancreatitis.

What postoperative care should be

To reduce the risk of complications, it is necessary to continue medication treatment. At the end of the operation, doctors prescribe parenteral nutrition (when the mixture is administered intravenously) in a proportion of 50-60 ml per 1 kg of human weight. It starts on the second day and lasts for several days.

To restore bowel function, doctors prescribe enteral nutrition (special nutritional mixtures). The solutions themselves are injected into the nose and mouth using a probe. The duration and type of food is determined by the doctor.

Fact: During the day, the doctor examines the wound and changes the dressing, keeping an eye on its cleanliness and condition. When replacing, it is necessary to use a drainage tube and antiseptics.

Diet

After five days from the day of the operation, it is necessary to make sure that there are no complications, positive dynamics of recovery and normal bowel function. If everything is in order, then natural nutrition is prescribed:

• first, a low-calorie diet - vegetable puree, compotes and jelly, meat broths;
• over time, you can increase the calorie content and eat dairy products, meat and eggs. The main thing is to listen to the body's reactions to food;
• it is strictly forbidden to consume confectionery and smoked products, spices, coffee, soda, legumes, chocolate.

Peritonitis is an inflammation that requires prompt medical treatment and medical supervision. The earlier the operation is performed, the more positive the prognosis will be and the lower the chances of serious complications. With the first signs of inflammation, you must immediately call an ambulance and not self-medicate.