Peritonitis diagnosis treatment. Peritonitis or acute abdomen

Peritonitis is a pathological condition characterized by inflammation of the thin connective tissue membrane (peritoneum) that covers the abdominal cavity from the inside.

In most cases, peritonitis occurs as a complication of various surgical pathologies. abdominal cavity accompanied by a violation of the integrity of the wall of the thick (in 32% of cases) or small intestine(13% of cases), appendix of the caecum (appendix) (3% of cases), stomach / duodenum(18% of cases) with the expiration of the contents of the gastrointestinal tract into the abdominal cavity.

Classification of peritonitis

1. According to the ways of spread of infection, the following types of peritonitis are distinguished:
2. Primary: due to the spread of infection through the blood (hematogenous) or lymph (lymphogenic) from distant foci of infection. An example is spontaneous bacterial peritonitis, diagnosed in patients with cirrhosis of the liver /, or tuberculous peritonitis in patients with pulmonary tuberculosis;
3. Secondary: occurs as a complication of acute surgical pathology, accompanied by perforation of the hollow organs of the abdominal cavity. The most common cause of secondary peritonitis is appendicitis (K35), perforated gastric ulcer (K25) or duodenal ulcer (K26), diverticulosis (K57), circulatory disorders in the branches of the mesenteric arteries (intestinal infarction, thrombosis of the mesenteric arteries) (K55.0), strangulated abdominal hernia (K46.0), intestinal obstruction caused by intussusception (K56.1) or volvulus (K56.2) of the intestine, acute pancreatitis (K85). Secondary peritonitis may be the result of a surgeon's mistake made during surgery on the abdominal cavity (failure of sutures on the intestine, damage to the walls of hollow organs through negligence). Any penetrating or blunt injury to the abdominal cavity also leads to secondary peritonitis (rupture of the spleen, liver, internal bleeding, stab or gunshot wound);
4. Tertiary: diagnosed in patients with a weak immune system who have a serious disease of other organs and systems (tuberculosis, HIV, AIDS).
5. Downstream classification:
6. Acute peritonitis;
7. Chronic peritonitis.
8. Depending on the presence of infection, there are:
9. Bacterial (microbial) peritonitis;
10. Aseptic / chemical peritonitis. Possible reasons aseptic peritonitis - chemicals (hydrochloric acid gastric juice), blood, bile, flowing into the abdominal cavity. Aseptic inflammation of the serous membrane of the abdominal cavity is possible in patients with systemic diseases of the connective tissue ( rheumatoid arthritis, systemic lupus erythematosus).
11. Classification by the nature of the exudate:
12. Dry peritonitis (without exudate);

Exudative peritonitis:

Serous;

fibrinous;

Purulent peritonitis;

Hemorrhagic.

Classification according to the prevalence of inflammation of the peritoneum:

Local (local) peritonitis (with damage to one area of ​​the abdominal cavity);

Widespread / diffuse peritonitis (with damage to 2-5 areas of the abdominal cavity);

Total (with the defeat of the entire peritoneum).

Causes of peritonitis

The immediate cause of peritonitis in the vast majority of cases is an infection that causes inflammation. Aseptic peritonitis associated with the outflow of sterile biological fluids into the abdominal cavity is considered as such only at the onset of the disease. After some time, infection inevitably occurs.

An example of true aseptic peritonitis is inflammation of the peritoneum in systemic diseases of the connective tissue, caused by an autoimmune process. Surgical treatment in such cases is usually not required.

In most cases, peritonitis is caused by gram-negative and gram-positive intestinal flora.

A specific infection can also cause peritonitis. Chlamydia (K67.0), gonococcal (K67.1), syphilitic (K67.2), tuberculous (K67.3) peritonitis are most often diagnosed. Chlamydial and gonococcal peritonitis is more typical for women, due to the presence of direct routes of infection from the pelvic organs to the abdominal cavity through the fallopian tubes.

Risk factors for peritonitis

The following pathological conditions and medical manipulations increase the risk of peritonitis:

• Ascites, cirrhosis of the liver;
• Severe diseases of other organs and systems;
• Chronic inflammatory diseases of the small pelvis in women;
• Peritonitis in the past in the same patient;
• Operative and diagnostic interventions on the abdominal cavity;
• Peritoneal dialysis (a procedure used to cleanse the blood of toxins and poisons).

The mechanism of occurrence of peritonitis

Consider the mechanism of peritonitis on the example of appendicitis (inflammation of the appendix of the caecum).

The peritoneum is a thin connective tissue membrane that lines the organs and walls of the abdominal cavity. Constantly produces a small amount of fluid that facilitates the sliding of internal organs, contains a large number of blood vessels and nerves. Normally, the peritoneum and abdominal cavity are sterile.

The caecum, like any other part of the large intestine, contains a huge amount of bacteria in its lumen. Under normal conditions, this microflora performs useful functions, participating in digestion, the synthesis of vitamins, and supports the immune system. However, when these same bacteria enter the sterile abdominal cavity, they begin to show their pathogenic properties, provoking inflammation and intoxication. The situation is complicated by the large area of ​​the peritoneum through which waste products of bacteria and toxins are absorbed.

In the first hours after the onset of appendicitis, inflammation of the appendix is ​​limited to its walls. The pain that occurs during this period is due to reactive irritation of the nerve endings located in the peritoneum, covering the appendix from all sides. As the disease progresses, inflammation leads to swelling and an increase in the permeability of the walls of the appendix (phlegmonous appendicitis). Peritonitis, starting at this stage, captures the own peritoneum of the appendix, which provokes intense pain in the right iliac region. Surgical removal of the appendix at this stage prevents possible complications in the form of diffuse peritonitis with the transition of inflammation to other areas of the abdominal cavity.

Delay in seeking medical help leads to gangrenous appendicitis, with necrosis and perforation of the wall of the appendix. The contents of the caecum and transudate enters directly into the abdominal cavity, seeding it with intestinal flora. A change in body position provokes the flow of an infected transudate into the subhepatic region and other parts of the abdomen, which leads to the spread of infection. 24 hours after the perforation of the appendix, we can talk about diffuse peritonitis, with paresis (paralysis) of the intestine.

The infectious process leads to the activation immune system, massive intoxication of the body and other complications. Without treatment, peritonitis leads to sepsis - blood poisoning that occurs with multiple organ failure, ending in death.

The body's response to infection depends on the state of immunity and health of the patient, the aggressiveness of the infection, the volume of intestinal contents that have leaked into the abdominal cavity.

Stages of peritonitis

There are 3 consecutive stages of peritonitis:

1. Reactive stage: lasts the first day after the onset of pain and is characterized by severe symptoms.
2. Toxic stage: lasts the next 24-72 hours. Accompanied by an increase in intoxication of the body and a decrease in local symptoms - abdominal pain, tension abdominal wall(period of imaginary well-being).
3. Terminal stage: severe subtotal or total peritonitis with massive intoxication, multiple organ failure, toxic shock and irreversible changes in the body.

Peritonitis in children

Peritonitis in childhood develops faster and is more aggressive than in adults. In newborns and infants, this pathology is fatal in 78% of cases. The situation is complicated by the lack of the child's ability to tell in detail and show what worries him and where he hurts. The only signs of pathology in such patients are constant crying, refusal of the breast, tension in the abdominal wall, high fever, blood in the stool. The main cause of peritonitis in children is volvulus, intestinal intussusception, ischemic infarcts of the intestine.

Peritonitis in the elderly

Unlike children, peritonitis in the elderly may present with mild pain and few symptoms. Pain syndrome is present only in 50% of patients, muscle tension of the abdominal wall - only in 34%. The reason is the reduced reactivity of the body and age-related changes. Moreover, older people with diabetes peritonitis can be almost asymptomatic. Late access to medical care due to lack of characteristic symptoms causes high mortality in patients of this age group.

Symptoms of peritonitis

• Strong sharp pains in a stomach, positive symptoms irritation of the peritoneum;
• Tension of the abdominal muscles (“board-shaped” abdomen);
• Nausea, without or with vomiting;
• Fever (in 80% of patients with peritonitis, a high temperature with chills is determined);
• Lack of appetite;
• Strong thirst (it is strictly forbidden to drink and feed the patient);
• Frequent liquid stool or lack of stool/off-gassing;
• Infrequent scanty urination;
• Sharp weakness;
• Tachycardia;
• Sticky cold sweat;
• Absence of sounds of intestinal peristalsis.

Diagnosis of peritonitis

Instrumental research methods are used to diagnose the causes of peritonitis and differential diagnosis diseases with similar symptoms. They include radiography of the abdomen, ECG, ultrasound of the genitourinary system, liver and biliary tract, pancreas, esophagogastroduodenoscopy (EFGDS). In disputed cases, apply computed tomography with contrast.

The minimum required set of laboratory tests:

• General blood test with leukoformula to determine leukocytosis;
• Amylase blood test (if acute pancreatitis is suspected);
• Urinalysis (exception acute pyelonephritis giving similar symptoms)
• Microscopic and bacteriological analysis of the transudate obtained during surgery, with seeding for sensitivity to antibiotics;
• Blood tests for group and Rh factor;
• Blood test for coagulation (coagulogram, hemostasiogram);
• Blood tests for HIV, RW, hepatitis B and C;
• Blood test for biochemistry.

Treatment of peritonitis

The main method of treatment is surgical. The purpose of surgery is to eliminate the causes that led to inflammation of the peritoneum. With appendicitis, this is the removal of the appendix; with a perforated ulcer - removal of the ulcer or radical gastrectomy (resection of part of the stomach); with volvulus of the intestines, strangulated hernia, with ischemic necrosis of the intestine - removal of a non-viable part of the organ. Surgery for peritonitis is the only available method of treatment that can save the life of the patient.

After elimination of the direct source of infection, the abdominal cavity is sanitized - peritoneal lavage. During this procedure, antiseptic solutions are poured into the abdominal cavity, which are then evacuated through drains (tubes that drain fluid to the outside).

Preparing for surgery for peritonitis

Preparing for surgical treatment peritonitis standard for any intervention on the abdominal cavity. It includes intensive antibiotic therapy, gastric and / or large intestine lavage, premedication (the use of drugs that facilitate immersion in anesthesia and prevent complications of anesthesia), measures to stabilize the patient's condition before surgery.

Medicines and preparations for peritonitis

The foundation drug therapy peritonitis - antibiotic therapy, the purpose of which is to eliminate the infection. Are used modern antibiotics from the group of fluoroquinolones, cephalosporins, penicillins (a specific drug is selected based on the results of a microbiological study or empirically).

Complications of peritonitis

Possible complications of peritonitis:

• Formation of an abscess of the abdominal cavity;
• Intestinal obstruction;
• Adhesive disease;
• Acute thrombophlebitis / thrombosis of the portal vein of the liver;
• Abscesses of the liver;
• Formation of intestinal fistulas;
• Syndrome of abdominal compression (pathological increase in pressure in the abdominal cavity);
• Nosocomial infection.

Proper lifestyle during the recovery period after peritonitis

The consequences of peritonitis and complete recovery of the body last several months. During this time, it is necessary to follow the recommendations of doctors: use a postoperative bandage that prevents the formation of postoperative hernia, do not lift weights, eat a healthy and balanced diet, lead an active lifestyle with dosed physical activity(outdoor walks, walking, breathing exercises, gymnastics).

Nutrition for peritonitis in the acute period is strictly prohibited (it is forbidden to take any food or liquid). In the early postoperative period appoint table No. 0 according to Pevzner - not strong meat broths, juices, jelly, jelly, fruit and berry decoctions. Meals are fractional, frequent, in small portions, 6-8 times a day. It is forbidden to take rough, hard food.

Prognosis for peritonitis

With timely provision medical care the prognosis is favorable. The risk of death is less than 5%. The lack of adequate diagnosis and treatment provokes complications in the form of shock, sepsis, multiple organ failure (mortality reaches 50%). The age of the patient less than 10 years and more than 65 years is also associated with a high risk to life.

Prevention of peritonitis

Primary prevention of peritonitis is not possible. Secondary prevention is timely diagnosis and treatment of pathologies leading to an acute abdomen. In patients with ascites/cirrhosis of the liver as primary prevention spontaneous bacterial peritonitis use antibiotic therapy.

Good day, dear readers!

In today's article, we will consider with you such a disease as peritonitis, as well as its symptoms, stages of development, causes, types, diagnosis, treatment, folk remedies, prevention and other useful information. So…

Peritonitis - what is this disease?

Peritonitis- an inflammatory disease of the peritoneum, accompanied by acute abdominal pain, muscle tension of the abdominal wall, elevated temperature body, nausea, flatulence, constipation and general severe malaise of the patient.

Peritoneum (lat. peritoneum)- serous membrane, consisting of parietal and visceral sheets, between which there is a cavity filled with serous fluid. The visceral layer covers the internal organs in the abdominal cavity, and the parietal layer lines its inner wall. The peritoneum protects the internal organs from infection, damage and other adverse factors affecting the body.

The main causes of peritonitis are internal, their perforations, as well as infection, mainly. For example, the cause of irritation, and after inflammation of the wall of the peritoneum, can be hydrochloric acid, released from the stomach with its ulcer with perforation. The same consequences can be in the presence of appendicitis, pancreatitis, diverticula, etc.

Peritonitis is a serious, life-threatening disease that requires urgent hospitalization and adequate treatment. If you slow down with the provision of medical care, the prognosis for the patient is very unfavorable.

Development of peritonitis

The course of peritonitis can be conditionally divided into three stages.

Peritonitis stage 1 (reactive, duration - up to 12 hours)- the initial reaction of the body to infection in the abdominal cavity, accompanied by a local inflammatory reaction of tissues in the form of edema, accumulation of exudate. The exudate is serous at the beginning, and as bacteria and protective cells (leukocytes) accumulate in it, it becomes purulent. The peritoneum has interesting feature- by the method of gluing and adhesions of sheets to separate (delimit) the pathogenic microflora from other parts of the body. Therefore, due to fibrin deposits, at this stage, the appearance of adhesions in the peritoneum and adjacent organs is characteristic. In addition, at the site of the inflammatory reaction, in adjacent organs, swelling and infiltration processes can be observed.

Peritonitis stage 2 (toxic, duration - up to 3-5 days)-accompanied by entry into the bloodstream and lymphatic system bacteria, waste products of the infection (endotoxins) and protein products (proteases, lysosomal enzymes, polypeptides, etc.), as well as a more active immunological (defensive) response of the body to the inflammatory process. There is an inhibition of the contractile activity of the intestine, degenerative changes surrounding organs, hemodynamic disorder (c), typical signs of septic (endotoxin) shock - bleeding disorders and others. In addition, symptoms such as nausea, diarrhea with constipation, general malaise, flatulence, fever, and abdominal pain are characteristic. The toxic phase of the disease can lead to the development of myocarditis, pericarditis and endocarditis, characterized by disruption of the entire cardiovascular system.

Peritonitis stage 3 (terminal, duration - from 6 to 21 days)- characterized high temperature, which after a while drops to low rates, rapid heart rate, decrease, blanching skin nausea, vomiting, rapid weight loss, sharp pains stomach, diarrhea. The function of the liver for the formation of protein decreases, due to which its level falls, and the amount of ammonium and glycol in the blood increases. The brain does not remain unaffected, the cells of which swell, and the amount of cerebrospinal fluid increases.

Pathogenesis in peritonitis

From the side circulatory system hypovolemia develops, which is accompanied by increased heart rate, increased blood pressure, which soon decreases to low values, a decrease in the rate of portal blood flow, a decrease in venous return to the heart, tachycardia.

From the gastrointestinal tract - as a reaction to the inflammatory process, intestinal atony appears. Due to circulatory disorders in the intestinal wall and irritation of its neuromuscular system with toxins, persistent paresis of the gastrointestinal tract develops, which in turn leads to hypovolemia, acid-base balance disorder, deposition of a large volume of fluid in the intestinal lumen, water disturbances, electrolyte, protein and carbohydrate metabolism. There are also signs of disseminated intravascular coagulation.

On the part of the respiratory organs - violations appear mainly in the later stages of the development of peritonitis and are characterized by hypoxia, impaired microcirculation in the lungs and their edema, lung perfusion appears, which, in combination with hypovolemia, leads to disruption of the myocardium and lungs.

On the part of the kidneys - as a result of the general reaction of the body to stress, spasms and processes of ischemia of the cortical layer appear at the first (reactive) stage of peritonitis, which, in combination with hypovolemia, leads to a deterioration in the functioning of the kidneys, the end result of which can be acute renal failure (ARF). ) or renal and hepatic insufficiency.

On the part of the liver - violations are observed at the initial stages of the development of the disease, and are characterized by hypovolemia and hypoxia of the liver tissues, which in the end can lead to parenchymal dystrophy.

Peritonitis Statistics

The end result of the development of peritonitis in 20-30% of cases is death, and in case of complications, mortality increases to 60%.

Peritonitis - ICD

ICD-10: K65;
ICD-9: 567.

The severity and symptoms of peritonitis largely depend on the severity of the underlying cause of the disease, infection, localization inflammatory process and the health status of the patient. However, consider the typical symptoms of the disease.

The first signs of peritonitis

• Periodic sharp pains in the abdomen;
• Increased body temperature;
• General malaise,;

The main symptoms of peritonitis

• Acute, especially aggravated by pressure on the anterior abdominal wall;
• Muscle tension in the anterior abdominal wall;
• Nausea, ;
• , which decreases sharply after a while;
• Rapid pulse,;
• , acrocyanosis;
• increased sweating;
• Symptom of Shchetkin-Blumberg;
• Symptom Mendel;
• Symptom Francicus;
• Resurrection symptom.

Complications of peritonitis

• Acute kidney failure(OPN);
• Syndrome of intra-abdominal hypertension (SIAH);
• septic shock;
• Fatal outcome.

Among the main causes of peritonitis are:

Inflammatory diseases of various organs located in the abdominal cavity - appendicitis, salpingitis.

Perforations in the organs of the gastrointestinal tract (stomach, intestines, gallbladder, etc.), which can act as complications or, appendicitis, destructive cholecystitis, ulcerative,. This leads to the fact that the contents of the stomach, gallbladder, Bladder(hydrochloric acid, bile, urine, blood) enters the free abdominal cavity, which causes its irritation, and then inflammation.

Video about peritonitis

Belly - so in the common people they called one of the important parts of the body. Usually a person does not pay attention to the state of his belly. However, it is this department that performs one of the important functions - bactericidal. The peritoneum has a fairly simple structure - two petals that are not interrupted, pass one into the other, create an airtight space and fix the internal organs. But if for some reason, then this leads to undesirable consequences ..

What is it - peritonitis?

No organ is deprived of the possibility of being inflamed. Most often, the infection penetrates even into areas that a person does not know about. What is peritonitis? This is an inflammation of the serous membrane of the abdominal cavity, which is called the peritoneum. There is another name for this disease - "".

Kinds

There are several types of peritonitis, according to various classifications:

most main reason Peritoneal peritonitis is an infection that rarely penetrates through the blood or lymph (in 2% of cases), and most often occurs due to a violation of the integrity of the pelvic organs or the abdominal cavity. Often, the disease occurs as a secondary disease, that is, against the background of some damage that is already observed in the patient. The main factors provoking peritonitis of the peritoneum are:

• - the cause of 50% of all peritonitis.
• Perforation of the duodenum or gastric ulcer is the cause of 15% of all peritonitis.
• Biliary or intestinal disorders are the cause of 10% of all cases of peritonitis. What diseases are distinguished here as provocateurs of inflammation of the peritoneum? Intestinal obstruction, perforation of ulcers in colitis, enterocolitis, cholelithiasis, diverticulitis, perforation of ulcers in Crohn's disease.
• Inflammation of the female reproductive system is the cause of 10% of all peritonitis. What diseases cause inflammation of the peritoneum? Salpingitis, rupture of an ovarian cyst or fallopian tube, pyosalpinx.
• Abdominal injury.

This also includes isolated cases associated with diseases of the pancreas, bladder and spleen.

Separately, aseptic peritonitis is isolated, which occurs not due to the penetration of infection into the abdominal cavity, but due to the aggressive effects of blood, urine, pancreatic juice. This type reasons are called toxic-chemical, since the liquid has a toxic effect on the abdominal cavity. Everything would be fine if, after a few hours, bacteria did not join the affected area and did not turn aseptic peritonitis into bacterial one.

A separate type of aseptic peritonitis is barium, when the substance goes beyond the gastrointestinal tract and fills the abdominal cavity. There are few such situations, but the mortality rate is more than 50%.

Symptoms and signs

Signs of inflammation of the peritoneum are divided into local and general. Local symptoms include:

• Pain is the most main symptom any peritonitis, which is first localized (in the affected area), and then becomes diffuse;
• Irritation of the peritoneum;
• Tension of the abdominal muscles occurs involuntarily as a reflex reaction of the body. Can be local or shared.

Common symptoms of peritoneal inflammation include:

1. Temperature;
2. Low pressure;
3. confusion;
4. repeated vomiting;
5. Decreased diuresis;
6. Increased acidity (acidosis);
7. Frequent heartbeat;
8. Dry skin, sharpness of facial features.

Symptoms of tuberculous peritonitis are similar to the symptoms of ordinary tuberculosis in respiratory diseases:

• Weight loss;
• Periodic cough;
• Fever that does not subside;
• Increased sweating.

In practice, doctors distinguish symptoms according to the stages of the course of the disease:

1. Reactive (initial):
   • Symptoms begin with local signs and develop to general ones in one or several days.
   • The patient lies on his back, legs bent to the stomach.
   • There is a temperature and frequent heartbeat.
   • There is a gag reflex and nausea.
   • The tongue becomes dry and coated.
   • There is shallow breathing.
   • The more acute the disease, the more confused consciousness becomes.
   • There are signs of the Shchetkin-Blumberg symptom.
2. Toxic:

• There are general symptoms with general intoxication. It develops up to 3 days after the onset of the disease.
• Violated water-electrolyte metabolism and metabolism.
• Breathing becomes frequent, shallow, intermittent.
• Tormented by vomiting, in which the waste masses have a fetid odor.
• There is dehydration, thirst, which cannot be eliminated by drinking. Over time, the amount of urine becomes scarce.
• Tongue coated brown.
• Convulsions or arrhythmia appear due to the loss of salts by the body.
• Muscle tension progresses to bloating.

1. Terminal:

• Occurs on the 4th day after the onset of the disease.
• There is dehydration and a pre-coma.
• The face changes: the features become pointed, the eyes and cheeks sink, the skin acquires an earthy color, the skin is so dry and tight that the temples flow.
• There are pains in the abdomen on palpation.
• The patient usually lies motionless.
• His mind is confused.
• The abdomen is strongly distended.
• Breathing becomes intermittent, and the pulse becomes thready.

Chronic form of peritonitis, as in other inflammatory diseases(for example, with colitis or gastritis), is asymptomatic. It has the following features:

1. increased sweating;
2. Anorexia;
3. temporary constipation;
4. slight temperature;
5. Temporary abdominal pain.

Peritonitis in a child

It is peritonitis that can be a serious cause for concern for parents if it appears in a child. This disease is quite rare, but if it appears, it brings a lot of problems. In 70% of cases, it leads to death, so here you should act immediately and seek medical help. Luckily, modern medicine able to reduce the mortality rate by up to 20%. Tuberculous peritonitis is the most common.

Since children often fall ill with various bacterial diseases, the risk of inflammation of the peritoneum is high. The infection penetrates through the blood to weak areas of the body and begins its reproduction. Therefore, here parents should not wait until the child recovers on his own, but proceed to his treatment for early stages to prevent sepsis.

Peritonitis in adults

Found in adults different kinds peritonitis. If we talk about the tuberculous form, then it often occurs in women due to the transfer of mycobacteria from the genitals. In women, the disease occurs 9 times more often than in men.

Diagnostics

Diagnosis of inflammation of the peritoneum begins with asking the patient about what symptoms bother him and what he was previously sick or sick of now. By a general examination (measurement of pulse, respiration and pressure), conclusions are drawn. To clarify the diagnosis, additional procedures are carried out:

• Laparoscopy.
• Ultrasound of the peritoneum.
• Hemogram (blood test).
• CT and MRI of the peritoneum.
• X-ray of the abdominal cavity.
• Analysis of feces, urine and vomit.
• Puncture of the inflamed area.

Treatment

Treatment of peritonitis is divided into hospital and out-of-hospital forms. Since the "acute abdomen" has a high mortality rate, the disease begins its treatment in a hospital form. The secondary nature makes you first eliminate the root cause: remove the appendix, purulent gallbladder, suture a perforated ulcer. That is, it is carried out surgery, after which they begin to eliminate peritonitis.

How to treat inflammation of the peritoneum? Medicines:

• Antibiotics (pecillin, aminoglycosides, macrolides).
• Infusion solutions of glucose.
• Detoxification drugs and sorbents (hemodez, 10% calcium chloride).
• Diuretics (furosemide).
• Antipyretics (ibuprofen, paracetamol).
• Antiemetic drugs (metoclopramide).
• Anticholinesterase drugs (prozerin, ubretide).
• Anticoagulants (heparin).
• Anabolic drugs (retabolil, insulin and glucose).

Painkillers are not prescribed because they lubricate clinical picture, which shows how the disease progresses. As for surgery, it is a mandatory procedure. Its purpose is to remove exudate, isolate the source of bacteria, resection, free the gastrointestinal tract from liquid and gases, sanitize the peritoneum.

Can peritonitis be treated at home?

At home, peritonitis cannot be cured, so you cannot treat the disease at home. Immediately at the first symptoms, hospitalization of the patient is required, since if left untreated, the likelihood of death is high. home care possible only after the patient has been cured, but even here it is periodically necessary to visit the surgeon to be examined.

Diet

During the treatment period, a diet becomes very important, which is divided into three stages:

1. Early - lasts up to 5 days - here the patient does not eat food, and all the necessary trace elements are administered to him intravenously.
2. The second - duration up to 3 weeks - the gradual introduction of natural food: jelly and jelly, soft-boiled eggs, meat broth, fruit and berry juices, vegetable puree.
3. Far - until full recovery of working capacity - coarser products are introduced gradually. Sweet and fried foods, seasonings, spices and heavy foods are still excluded.

Lifespan

How many live with peritonitis? This forecast is unpredictable. The mortality rate is very high, so life expectancy decreases as the disease progresses (lasts up to 6 days if left untreated). If you delay treatment, then the patient dies. Main complications this disease are:

• Sepsis,
• hepatic encephalopathy,
• gangrene of the intestine
• hepatorenal syndrome,
• Adhesions inside the peritoneum,
• Abscess,
• septic shock,
• pulmonary complications,
• Dehydration.

The only preventive measure is a timely visit to the doctor. At the same time, it is important healthy eating and curing other infectious diseases of the body.

The peritoneum is a shell in the form of two sheets. The spaces they form contain serous fluid. The main function of the peritoneum is to create partitions between internal organs and muscles, as well as fixation in limbo with the help of mesentery and ligaments. The peritoneum protects the internal organs in yet another way. When it encounters microbes, substances are produced that lead to the death of harmful microorganisms. Peritonitis - inflammation of the peritoneum, leading to disruption of all systems and organs located in this area, what are the symptoms of the pathology?

Peritonitis - inflammation of the peritoneum

Peritonitis begins to develop when the peritoneum cannot cope with the huge number of invading and multiplying microbes. In this situation, the peritoneum becomes a source that spreads the infection. This disease is life threatening and can end sadly if adequate measures are not taken to localize the inflammation and normalize the condition.

The introduction and spread of infection in the abdominal cavity most often develops as a result of trauma to the organs of this area, a violation of their integrity. The cause may be a disease of the internal organs. Occasionally, peritonitis can develop when microorganisms are brought into this area by blood or lymph.

In most cases, peritonitis does not occur as an independent disease, but as a complication of diseases of the abdominal organs. For example, appendicitis, intestinal obstruction, as well as duodenal ulcers, in case of untimely measures taken, end in peritonitis. The destruction of the organ after the collapse of the tumor leads to inflammation of the peritoneum. The necrosis of a fragment of the intestine during a hernia, trauma to the abdominal cavity, accompanied by injury, rupture of the organ, partial destruction of the wall of the stomach or intestines foreign body may also result in peritonitis.

Sometimes, with heart disease, fluid accumulates in the abdominal cavity, which suppurates in the event of an unfavorable development of events. This becomes another cause of peritonitis.

Not all types of peritonitis are caused by pathogens. For example, getting into the abdominal cavity of blood due to violation of the integrity of the vessel also leads to peritonitis. In this case, the type of disease is called aseptic or non-microbial. The disease at this level lasts no more than 6 hours. After this period, microbes from the intestinal zone penetrate into the hematoma. After that, peritonitis becomes normal.

Signs of peritonitis

Manifestations of peritonitis are due to the reasons that provoked its development. But the main features of this or that stage coincide in any case.

Reactive stage

This is the first stage, it takes the first day of the course of the disease. The damage is local. Patients first feel sharp pains that appear unexpectedly. In this case, you can accurately determine the place where the pain comes from. Some compare the pain at this stage with a dagger strike.

Localization of pain is associated with the organ that became the source of the development of the disease. For example, with appendicitis, pain will be felt in the lower lateral zone on the right. If this is a perforation of a stomach ulcer, then the pain will appear in the hypochondrium on the left or. The pain is felt strongly, while it gradually spreads.

Sometimes there are periods when the pain seems to subside. But this is not for long. Relief lasts no more than 2 - 3 hours. Then everything escalates.

The patient has a rather characteristic appearance:

• pale skin, bluish tint;
• cold sweat;
• suffering expression.

Pain greatly disturbs a person, he, as a rule, tries to alleviate their intensity by taking certain postures. For example, lie on your side and tuck your knees, do not cough, do not inflate your stomach.

A characteristic symptom of peritonitis is a disc-shaped abdomen. This symptom is expressed in an overly tense abdomen. His feeling is very painful. To check for peritonitis, you can apply the Shchetkin-Blumberg method: press on the abdomen, and then quickly remove your hand.

Also typical signs will be false urge to defecate or urinate, repeated vomiting many times. Other signs that are considered symptoms of peritonitis indicate intoxication of the body. This is an increase in temperature, rapid pulse, dry mouth, intense thirst.

toxic

This is the second stage. During this period, the person is in a serious condition. All signs indicating the presence of poisoning are manifested. This stage takes about two days, begins 24 hours after the onset of the disease. Symptoms of the first stage are smoothed out. The muscles of the abdominal wall are slightly tense, they can generally be normal. Pain sensations are not strong, blurry. The appearance of a person at the moment also has common typical features:

• pale lips;
• cold extremities;
• bluish nose, ears, nails.

Dry mouth persists, consciousness may be disturbed. This is expressed in complete indifference, less often in excitement. The patient may lose consciousness. The patient lies without moving. Doesn't respond to palpation. persists, only the vomit acquires a different color. They become dark, brown, fetid. Little or no urine. The temperature rises to very high figures: 40 - 42 °. Breathing becomes unstable, the pulse is very weak.

Terminal stage (irreversible)

This is the third stage, it comes three days after the onset of the disease. After three, and sometimes even after two days, it ends with the death of the patient. The condition can be classified as extremely serious. The appearance of all patients in this situation is the same. This complex of external manifestations is called the "face of Hippocrates":

• cyanotic moist skin;
• sunken cheeks;
• overly sharp features.

The abdomen is soft, there is no pain at all, palpation does not cause discomfort. The pulse is not palpable, breathing is weak, may be completely absent, pressure is not determined. Human life at this stage is possible only in intensive care with the use of artificial life support systems.

Diagnosis of peritonitis

If peritonitis has developed in a confined space, as occurs in encysted peritonitis, it can be difficult to make a diagnosis. Ulcers, which are a consequence of laparotomy interventions (subdiaphragmatic, interloop, pelvic, abscesses, ulcers of the right iliac fossa), also have difficulties in diagnosing.

With sluggish processes, the disease may manifest itself for a short time. painful sensations followed by general malaise. Anemia, exhaustion, a person may develop a fever. There are no local signs, so the doctor may consider that an infection has settled in the body or a tumor process is going on somewhere.

It is very difficult to identify this type of peritonitis. It is necessary to conduct a comprehensive examination, including many tests, vaginal, rectal examinations. Of course, such a diagnosis is best done in a hospital. The diagnosis can be made by analyzing the entire clinical picture. Attention is paid to whether there is intoxication, and, of course, to the condition of the peritoneum. To make sure the diagnosis is correct, use the result of radiography, laparoscopy.

If the patient is suspected of local or diffuse peritonitis, he is urgently sent to the hospital.

You should not give drugs to eliminate pain, because this greatly changes the picture of what is happening. Then in the hospital it may be difficult to make a diagnosis. To alleviate the condition, an ice pack is placed on the stomach. Polyglucin is administered intravenously. It will help to avoid severe dehydration and infectious-toxic shock. It is necessary to inject the drug drip. Quantity 400 - 800 ml. glucose (5%) or sodium chloride is also administered. These drugs facilitate the general condition of the patient, create safer conditions for transportation, and serve as some preparation for the upcoming operation.

Treatment of peritonitis

If the diagnosis is established, an emergency operation is performed. During the operation, they act according to the circumstances. After examining all tissues, the affected areas of organs are sutured, tumors are removed, and bleeding is stopped. Existing purulent foci are brought back to normal, they are washed with antiseptic solutions. It is advisable to use Ringer's solution.

If inflammation has affected significant areas, then washing is carried out for several days. After the operation is administered in large quantities. Also direct actions to eliminate dehydration.

The famous surgeon S. I. Spasokukotsky noted back in 1926 that if the operation was performed in the first hours after the development of inflammation, then 90% of patients recover. The operation during the first day gives recovery in 50% of cases. And only 10% have a chance to survive if the operation is done later than the third day.

In our time, approximately the same trend continues. Surgical intervention on the first day ends with recovery. At the second stage, the success of treatment is already doubtful. Recovery occurs if the organs and systems are not severely affected. At the third stage, it is not possible to correct the condition, because irreparable changes occur with the internal organs.

Preventive actions

Prevention of this disease is to inform people about. Only people who have knowledge about the stages of this disease and about its other features can take adequate measures in time and avoid the sad part.

Video material for the curious, but not for the faint of heart. Surgical complications. Relaparoscopy for biliary peritonitis:

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Peritonitis is inflammation of the abdominal cavity. It manifests itself as a complication after pathologies - the entry of microbes into the body through the blood or lymph, which is called primary peritonitis. Secondary peritonitis refers to damage and inflammation of the digestive organs. 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 the 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. To local pains are added also general symptoms.

In the normal state, there is a small volume of fluid between the sheets of the abdominal cavity. Inflammation begins for one of the reasons:

• entry of harmful microorganisms- Streptococcus, Pseudomonas aeruginosa or coli, Klebsiella, Proteus, pneumococcus and others;
• organ perforation digestive system . During perforation, a through defect is formed in the organ, which leads to the ingress of various fluids into the peritoneum;
• accidental damage to internal organs during a surgical operation;
• mechanical damage to the abdomen at home ;
• diseases organs of the digestive system- from salpingitis and appendicitis to cholecystitis;
• inflammation of the tissue behind the peritoneum and abdominal walls, unrelated to internals. These are purulent processes, phlegmon and others.

Important. Increased risk of organ damage and subsequent inflammation during exacerbations and late treatment the following diseases: ulcer in duodenum or stomach, nonspecific ulcerative colitis on the colon, reactive pancreatitis, intestinal obstruction, phlegmonous or gangrenous appendicitis, destructive cholecystitis of the gallbladder.

Classification

The disease is classified according to several criteria at once:

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

The form

Distinguish between chronic and sharp shape. 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. Deadline - 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 pressure, increased heart rate up to 110-120 beats.
3. Terminal. Deadline - 3 days after the second stage. Severe 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 greatly reduced blood pressure.

Prevalence

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

Reason for development

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

Table 1. Types of peritonitis

The sixth type includes cryptogenic peritonitis, in which there is no way to accurately determine the cause of inflammation.

Type of pathogen

There are two categories - bacterial and aseptic. The first occurs due to 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.

Also exists mixed type, which 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 are aggravated by pressing (palpation). severe pain force a person to lie only in the fetal position: on the side with bent legs brought to the stomach.

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

Fact: at the same time, the abdominal muscles are in unrelenting tension, regardless of the stage.

Stages of inflammation

Table 1 Stages of inflammation

Complications and consequences

In case of untimely treatment or complex 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;
• eventeration;
• bleeding;
• dehydration;
• encephalopathy;
• intestinal fistulas;
• abscess of the peritoneum;
• pathology in the kidney area;
• intestinal obstruction;
• necrosis of intestinal tissue;
• multiple organ failure.

How Doctors Diagnose the Disease

With peritonitis, the following types of diagnostics are carried out:

1. Analysis of complaints of a person and his lifestyle.
2. Inspection physical condition and palpation of the abdomen. characteristic feature- the desire to lie in the fetal position.
3. General urine analysis.
4. Measurement of temperature and blood pressure.
5. Ultrasound of the peritoneum to determine free fluid.
6. Clinical blood test to determine leukocytosis - changes cellular composition with an increase in the number of white blood cells.
7. Rectal and vaginal examination to determine severe pain in the region of 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 a laparoscopy - modern look operations using a special device that makes small holes in the abdomen.

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

How is the treatment

Required surgery and course medications. The operation allows you to eliminate the causes that caused peritonitis and drain the peritoneum (remove the fluid that has accumulated inside). During surgery, doctors:

• carry out preparation - clean and wash the gastrointestinal tract, produce anesthesia;
• cut the anterior wall of the peritoneum;
• eliminate the source. It all comes down to the cause of inflammation. For example, doctors may remove the gallbladder, appendix, suture the walls of the organ, or resect the ulcer;
• wash the peritoneum with antiseptic agents;
• perform bowel decompression;
• introduce a drainage system;
• suturing the wound.

Important: in no case should you arbitrarily take painkillers to stop the pain effect. This will reduce the severity of symptoms, making it harder for a doctor to make a diagnosis.

Medical treatment

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

Fact: Inflammation prevention is proper treatment and control of diseases of the digestive system, whether acute appendicitis, cholecystitis, ulcers in the stomach or duodenum, pancreatitis.

What should be the postoperative care

To reduce the risk of complications, it is necessary to continue treatment with medications. At the end of the operation, doctors prescribe parenteral nutrition(when mixtures are 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 the functioning of the intestines, doctors prescribe enteral type nutrition (special nutritional mixtures). The solutions themselves are injected into the nose and mouth with a probe. The duration and type of nutrition is determined by the doctor.

Fact: During the day, the doctor examines the wound and changes the bandage, keeping it clean and in good 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, the positive dynamics of recovery and the normal functioning of the intestine. If everything is in order, then natural nutrition is prescribed:

• first 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 use confectionery and smoked products, spices, coffee, soda, bean dishes, chocolate.

Peritonitis refers to inflammation that requires prompt medical treatment and control by physicians. The sooner the operation is performed, the better the prognosis will be and the lower the chances of serious complications. With the first signs of inflammation, you must immediately call ambulance and do not self-medicate.