Peritonitis - Causes, Symptoms and Treatment .MF .
peritonitis - an inflammation of the peritoneum, which is accompanied by the poisoning of the body and the concomitant disruption of many organs and systems.Peritoneum - a thin connective tissue sheets that cover the inside of the abdominal cavity, restricting it from muscles, and viscera, separating them from each other.The peritoneum has a remarkable property - when exposed to pathogens her she begins to produce substances that cause their death.In case where the amount exceeds the microbial barrier properties of the peritoneum, it itself becomes a source of disease and peritonitis develops.Peritonitis refers to life-threatening conditions, and at untimely seeking medical prognosis is usually unfavorable.
Causes of peritonitis
leading role in the occurrence of peritonitis plays a massive entry of germs into the abdominal cavity.Typically, this happens when you break the walls of the abdominal cavity organ due to disease or injury.Less peritonitis develops in a skid of infection through the bloodstr
most often peritonitis complicated diseases such as appendicitis, perforated gastric ulcer or duodenal ulcer, intestinal obstruction, necrosis of part of the colon with a hernia, organ destruction as a result of the collapse of the tumor, as well as abdominal trauma injuries or organ rupture, damage to the lining of the stomach orintestinal foreign body.Sometimes
peritonitis occurs when blood enters the peritoneal cavity, such as rupture of the vessel.This is called peritonitis-bacterial or aseptic.But, usually after 4-6 hours of bruising to penetrate intestinal bacteria and bacterial peritonitis becomes.
also to the development of peritonitis can cause fester much fluid (ascites), which accumulates in the abdominal cavity diseases such as kidney or heart failure.
symptoms of peritonitis
external manifestations depend on the symptoms of the disease that is the cause of peritonitis, and can vary greatly.Still, depending on the time that has elapsed from the onset of inflammation, peritonitis conditionally distinguish several stages.
first stage - reactive - the first day of the disease.It is characterized by severe local manifestations.Typically, the pain occurs suddenly, in a well-defined area.The appearance and the nature of the pain is sometimes compared with the sensations when struck with a dagger.At this time the hub is determined by pain, usually in the affected organ, such as the appendix at break - in the right area inferolateral, gastric ulcer perforation - hypochondrium left and / or epigastric.The pain is very intense, with a tendency to spread.Pain is often a constant, but sometimes a symptom of an imaginary being.At the same time the pain becomes less intense, calm patients.After 2-3 hours the pain appears again.
Characteristic appearance of the patient - the skin is pale, sometimes earthy gray or bluish hue, covered with cold sweat on his face an expression of suffering.The patient tries to alleviate the suffering - makes forced position on your back or on your side with those given to the stomach down, trying not to inflate when breathing belly, holding back a cough.
Forced position at peritonitis
Muscle tension is so pronounced that talk about wooden belly.Typically, abdominal palpation causes significant pain.When peritonitis pain increases with the rapid withdrawal of the hand after the pressure on the stomach.This feature is so typical, that was in a separate symptom - a symptom Shchetkina-Blumberg.
The patient may experience repeated vomiting, which does not bring relief, false urges to urination, defecation.Already at this stage the body manifest symptoms of poisoning such as increase in body temperature to 38 degrees, chills, rapid weak pulse, dry tongue, cheeks, severe thirst.
Second stage of peritonitis - toxic - characterized by more severe general condition with severe symptoms of poisoning organism.Develops 24-72 hours of onset.However, local manifestations such as abdominal pain, muscle tension anterior abdominal wall, are mild or absent.Facial features are sharpened against the background of a pronounced pallor of the lips, the tip of the nose, earlobes, nails become cyanotic.Hands and feet are cold to the touch.Develops impaired consciousness (severe agitation, or often, a complete indifference).Periodically complete loss of consciousness.The patient lies motionless on his back, stomach feeling does not cause any sensations.Worried dry mouth and thirst.Continues painful vomiting, not bringing relief.Vomit is dark brown, with an unpleasant odor.Dramatically reducing the amount of urine until her absence.The body temperature to 40-42 degrees, shortness of breath, pulse frequent, barely perceptible.
third stage - an irreversible or terminal. develops after 3 days from the onset of the disease and, unfortunately, within 2-3 days ends in death.Overall condition is very serious.At this stage, symptoms are so characteristic and similar in all cases that they were united under the name of "Hippocratic face": wet pale bluish skin, sunken cheeks, sharpened features.When the feeling of tension of the abdominal muscles are not available, there is no pain.Missing or broken sharply breathing, blood pressure and pulse are not defined.Usually, at this time patients are in intensive care units in the conditions of artificial life support.
diagnosis of peritonitis is based on the identification of external signs, symptoms specific to the disease that caused peritonitis, as well as laboratory and instrumental methods of investigation.The blood test evidence of inflammation determined - an increase of leukocytes, erythrocytes may reduce the level of hemoglobin and, at a later stage - a violation of the coagulation system.When ultrasound is diagnosed pathology of the body, which was complicated by peritonitis, as well as the prevalence of infectious focus.
Early treatment for medical help determine the prognosis of the disease course.Therefore, in the event of intense pain in the abdomen, which does not decrease after taking pain medication, nausea, vomiting, fever, you should immediately seek medical attention.In this case, need urgent hospitalization in a medical institution.
Treatment of peritonitis
peritonitis treatment with surgery alone.As a rule, you need emergency surgery at a proven diagnosis.During the operation, inspection must be provided affected organ - inflammatory source, if necessary - suturing wall defect, tumor removal or stop bleeding.It is also necessary to remove the purulent foci by thorough rinsing of the abdominal cavity with antiseptic solutions such as Ringer's solution.With diffuse peritonitis may require additional washing of the first, second and subsequent days after surgery.After surgical treatment shows massive antibiotic therapy and correction of water and electrolyte imbalance.
In 1926, the eminent surgeon SI Spasokukotsky defined the forecast of a favorable outcome in peritonitis: "When peritonitis operation in the early hours to give 90% recovery, on the first day - 50%, after the third day - only 10%", andnot much has changed since then.Thus, the first stage of the process, when general poisoning of the body is missing or poorly expressed, with timely treatment ends favorably.When the massive action of toxins (second stage) prognosis for recovery becomes doubtful, and entirely dependent on the degree of severity of organs and systems.The third stage is characterized by almost one hundred percent mortality rate, expressed as the developing organ systems failure, which is not subject to correction.
Prevention of peritonitis
Prevention of peritonitis is that everyone with a particular disease was the most warned about possible complications and have a clear sequence of actions at the slightest suspicion of an inflammation of the peritoneum, which consists in the earliest possible call the brigade ambulance.
therapists Sirotkin EV