SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : THE ACUTE PERITONITIS (PERITONITIS ACUTA) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. Develops when injected into the peritoneal cavity and the development of infection (E. coli, Streptococcus, Staphylococcus, pneumococcus, gonococcus, anaerobes; often preinfection). Rarely, aseptic peritonitis when exposed to the peritoneum irritating substances (alcohol, iodine tincture, urine, bile).
The pathogenesis. Origin distinguish traumatic peritonitis, postoperative, hematogenous, secondary (ruptured by continued). The prevalence of peritonitis are divided into flooded and encysted, by the nature of the effusion - serous, fibrinous, purulent, septic and hemorrhagic. The reaction of the peritoneum is hyperemia, effusion (in septic cases, the effusion may be absent), hyperemic, the peritoneum is stripped Shine, covered with bloom. The most favorable fibrinous effusion, demarcates the process of free abdominal cavity, formation of infiltration or encysted peritonitis.
Symptoms. Peritonitis develops more often in the not diagnosed and not treated in a timely manner of any primary disease (injury to bowel, appendicitis, perforated ulcer, intestinal obstruction), so the picture of the disease is the sum of the symptoms of the disease, which led to peritonitis with several layers of symptoms actually peritonitis. Early symptoms - mainly local. Pain of varying intensity, especially sharp when the perforations, localized or diffuse, with greatest sensitivity at the starting point of peritonitis. Positive symptom Shchetkina-Blomberg. The pain is absent only in severe cases of septic peritonitis and in later periods of the disease. Reflex tension of the abdominal muscles is inverted, doskoobraznye, scaphoid abdomen (not if peritonitis in the pelvis and in the later cases of peritoneal sepsis - is replaced by the stretching of the muscles swollen belly). Reflex vomiting small amounts (regurgitation), a painful, prolonged hiccups, dry tongue, the cessation of peristalsis (at rest in the gut). Slow and voltage pulse. A significant difference between the temperature in the rectum and in the armpit. Exudate in the abdominal cavity and flatulence usually develop in the later periods of the disease. Common symptoms of intoxication: the acceleration and the weakening of the rail, the divergence of the pulse and temperature curves with increased heart rate, not corresponding to the temperature, change the appearance of the patient (the mask of Hippocrates), rapid shallow breathing, the indifference to the surrounding or euphoria, cold sweat, icteric staining of the sclera, leukocytosis, left shift and change from urine (protein, cylinders, indican).
For peritonitis varies depending on the prevalence, microbial flora, General condition, previous diseases. Picture of peritonitis develops within 1 to 2 days, in severe septic, especially postoperative, peritonitis - sometimes within days. Faltering peritonitis, especially in immunocompromised (cancer) patients, provide long-term course.
Recognition is no problem only in advanced cases, when it ought to be considered late. Recognition prevents the appointment of a drug (morphine), which is contraindicated in all cases of suspected peritonitis. The most difficult diferenciacija from colic (hepatic, renal, lead), tablecheck crises, spastic and paralytic ileus, bleeding into the retroperitoneal tissue.
Timely and correct treatment of diseases, complicated by peritonitis.
Treatment of peritonitis, in addition to pneumococcal and gonococcal, is in emergency surgery (removal of the Appendix cecum, suturing wounds, mending wounded intestinal loops) and the suction effusion. Control of infection and intoxication: penicillin into the abdominal cavity and intramuscularly, sulfa drugs, poluciaetsea position, an intravenous drip to 3 to 5 l per day of glucose, blood, saline solution; heart drugs, warming the patient. To combat the toxicity of the intestine, due to paresis of the intestine, apply lavage and permanent removal and suction the contents of the stomach and intestine through a tube introduced through the bottom of the bow for a long time. For the same purpose apply an operation overlay pendant eurotopia.
For discharge of the gas - venting tube, gastric lavage, siphon enemas.