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Peritonitis, what is it? Symptoms and treatment. Symptoms and treatment of purulent intestinal peritonitis

If inflammation occurs in abdominal cavity, you need to call urgently ambulance, otherwise the person may not be saved. In gastroenterology, inflammation is called inflammation. It can be complete or limited (affecting only a specific part of the abdominal cavity). In this case, the area is inflamed, in which there is a lot of different organs. The main cause of peritonitis is bacteria that get inside. The sooner you see a doctor, the better. Is it possible to cure peritonitis without consequences?

Symptoms of peritonitis

Unbearable pain in the abdominal area.
Body temperature rises.
The stomach swells and becomes hard.
The person feels unwell.
Nausea and severe vomiting.
Violated gastric work- bother constant constipation, increased flatulence.

Features of the inflammatory process in the abdominal cavity

Peritonitis does not appear just like that; it is necessarily preceded by an infection - bacteria, enterococci. It is especially dangerous when an ulcer of the intestines or stomach bursts, because of this, fluid from the damaged organ begins to accumulate in the abdominal cavity, resulting in an inflammatory process.

Secondary peritonitis can be a consequence of:

Rupture of the appendix.
Inflammatory process in the gallbladder.

Primary peritonitis develops very rarely; it usually occurs in people with weak immune system. An inflammatory process in the abdominal area occurs when a bacterium enters the bloodstream and begins to spread throughout all organs.

With local peritonitis, only local ailments occur: strong pain in the abdominal area, slight increase body temperature. In this situation, it is necessary to urgently go to a gastroenterologist.

The diffuse type of peritonitis is especially dangerous, in which the inflammatory process begins to affect other organs. If measures are not taken in a timely manner, everything may end in the death of the patient.

Causes of peritonitis in the abdominal area

The pathological process does not arise without reason; before this, problems necessarily arise with the internal abdominal organs. Most often, peritonitis is a consequence of a rupture of the intestines, appendix, stomach, gallbladder, as a result of which the contents end up in the abdominal area and an inflammatory process develops.

Gastroenterologists distinguish 3 types of peritonitis :

Infectious.
Chemically toxic.
Peritonitis after irradiation.

The inflammatory process is most often triggered by a bacterial intestinal infection. In chemical-toxic peritonitis, it first becomes inflamed gallbladder, then it ruptures and the fluid ends up in the abdominal area (often it ends in purulent peritonitis).

In some situations, peritonitis appears after an x-ray, when contrast agent. Quite often there are cases when peritonitis develops after surgery due to the use of suture material.

Rarely inflammation appears:

For a malignant tumor.
When entering bacterial infection during the operation.
If damaged internal organs or abdominal wall.

What to do if you have peritonitis?

If you have unbearable pain in the abdominal area, you should immediately consult a gastroenterologist. It is especially dangerous when the abdomen is hard, this means that peritonitis can spread to other organs.

When severe pain bothers you, you must immediately call an ambulance, they will take you to the hospital, and they will provide assistance there. In addition to a gastroenterologist, you need to see a radiologist.

Diagnosis of peritonitis

The first thing to do is definitely do an ultrasound. abdominal organs. When identifying pathology, the following are used: diagnostic methods :

A thorough examination by a doctor - tapping, palpation, checking the elasticity of the abdominal walls.
Study of bowel sounds.
Control of heart rate and temperature.
Blood analysis.
X-ray of the abdominal cavity.
Examination of the lungs and heart.

It is necessary to diagnose the pathology as early as possible. If the patient is in critical condition, the abdominal wall is opened and examined.

Course of therapy for inflammation of the abdominal area

First of all, the doctor prescribes a course of antibiotics, with which you can prevent complications in the future. Before surgical intervention The surgeon may apply ice to the abdominal area. Also for normalization blood pressure, heart function, cardiac medications are prescribed:

Cordiamin.
Caffeine.
Cordiazol.

In some cases, a blood transfusion or subcutaneous infusion of saline is necessary.

Most often, surgery is required. She may be different types, this determines how long the recovery process will take. The operation consists of cleansing the abdominal area of pus. Removed during the procedure pathogenic microflora and is completely restored intestinal function. Streptomycin and Penicillin are administered intramuscularly. Drainage and tampons can be inserted into the abdominal area. The abscess can be removed through the rectum, vagina, and sometimes an incision is made in the abdominal wall.

The doctor must take into account that the patient is losing a large amount of fluid, so he prescribes saline or Ringer’s solution; glucose can be injected under the skin. IN severe cases blood transfusion is necessary.

It is very important to remember preventive measures. At the slightest unpleasant sensations in the abdominal area, consult your doctor immediately. Remember that peritonitis can cause death in the patient, so you should not start it.

Thus, peritonitis is a serious pathology that requires urgent surgical intervention, special treatment, otherwise there may be serious consequences. To prevent peritonitis, it is necessary to be observed by a doctor in a timely manner, and not to bring yourself to a serious condition.

Peritonitis is the result of a violation normal functioning organs of the abdominal cavity due to intoxication of the body, which stimulates inflammation in the peritoneum.

Peritonitis - what kind of disease is it?

Connective tissue internal walls The abdominal cavity (parietal peritoneum) fixes the internal organs of the abdominal area through their membranes (visceral peritoneum). The most dependent in this position are the liver, gall bladder, middle part rectum and two sections colon, since they are covered on three sides connective tissue. It acts as a delimiter between the abdominal muscles and its internal organs.

IN in good condition The peritoneum performs several functions.

Resorptive (suction). The peritoneum absorbs up to 70 liters per day of protein breakdown products, sequestering fluid and other elements.
Exudative function (excretory). The peritoneum secretes fibrin and secreted fluid.

If the functioning of these functions is disrupted due to a specific virus or infection entering the body, fluid may begin to accumulate in the space between the parietal and visceral peritoneum. Its excess provokes the onset of inflammatory processes, which cause the production large quantity toxins. This phenomenon is called peritonitis.

The lack of protective mechanisms at the local level in the peritoneum can lead to poisoning of the body. With timely medical care in case of local peritonitis, the probability of death does not exceed 6%. If the inflammation of the peritoneum is widespread, the probability of death is possible in more than 45% of cases.

Prerequisites for the development of peritonitis:

processes of inflammation in the organs of the peritoneum, for example, appendicitis;
damage to abdominal organs;
surgical intervention in the abdominal organs;
processes of suppuration of any nature that are not related to the internal organs of the peritoneum.

According to the nature of occurrence and its specificity, peritonitis is divided into three types.

Primary. It is the result of harmful viruses or infection through the lymph or blood. In turn, it is divided into:

spontaneous child (preschool girls are most often at risk);
spontaneous adult (as a result of hemodialysis for renal failure);
primary peritonitis as a consequence of active tuberculosis.

Secondary. Caused by damage or inflammation of the internal organs of the abdominal cavity. This includes:

peritonitis as a consequence of a violation of the integrity of the membrane of the internal organs of the peritoneum;
peritonitis caused by abdominal trauma;
peritonitis in postoperative period as a consequence of the operation.

Tertiary. Such peritonitis is rare and is a relapse of an existing disease. Most often, its occurrence is accompanied by a failure of the internal organs of the abdominal cavity. The body loses its protective properties, treatment does not produce results, and the course of the disease leads to fatal outcome.

There are other classifications of peritonitis. Depending on the pathogen, the disease is divided into two types.

Bacterial. Caused by aerobic and anaerobic microorganisms, For example, coli, staphylococci, clostridia, etc. The most common cause of peritonitis is the introduction of several harmful microorganisms into the body at once.
Aseptic. It develops in the process of contact of the peritoneum with the contents of the stomach, intestines, blood, bile or pancreatic juice. As a result, within a few hours pancreatitis passes from the aseptic type to the bacterial type.

By degree of distribution inflammatory process distinguish:

local peritonitis(one part of the peritoneal cavity is affected);
common(covers from two to five departments);
total(managed to hit six or more parts of the abdominal cavity).

Peritonitis is accompanied by local and general symptoms. The first arise as a result of irritation of the peritoneum, for example, by gastric juice or bile. As a result of this process, the stomach begins to ache, the muscles of the frontal wall of the abdominal cavity are in a tense state. General symptoms the course of peritonitis occurs in conjunction with the body’s attempts to get rid of toxins: nausea, reflex vomiting, general weakness, fog.

The main symptoms of the disease also include:

extensive abdominal pain, the specific source of which cannot be determined without a doctor’s diagnosis;
dry mucous membranes;
increased heart rate up to 140 beats per minute;
stool retention and bloating;
cold sweat;
pale skin;
the tongue acquires a dark coating;
the pain is more easily tolerated when lying on your side with your knees tucked to your chest (“fetal position”).

Stages of peritonitis

During the course of the disease, experts distinguish three stages.

Diagnosis of peritonitis

First of all, the doctor performs a palpation examination of the abdomen. With its help, the tone of the muscles of the anterior wall of the peritoneum is established, the areas that react most acutely to inspection are identified, and the intensity of muscle resistance to palpation is determined.

The doctor also prescribes a blood test, a rectal examination for men and a vaginal examination for women. In combination with an examination, the patient may be sent to X-ray examination and ultrasound of the internal organs of the abdominal cavity to identify areas of fluid accumulation. If the above diagnostic methods are insufficient, the doctor may resort to laparocentnesis - taking a puncture to determine the composition of excess fluid in the abdominal cavity.

Treatment of peritonitis

If the doctor detects peritonitis in the patient, the need for surgical intervention becomes urgent. The algorithm for eliminating the disease is as follows.

The sooner surgery is performed, the greater the likelihood of recovery. If peritonitis is diagnosed two days after its occurrence, the probability of death exceeds 45%.

Postoperative care

Continuation drug treatment during the rehabilitation period is integral in the recovery process. In the postoperative period, the patient is also prescribed medications various groups: antibiotics, disinfectants, infusion solutions, protein preparations, anti-inflammatory, antiemetic and agents that inhibit cholinesterase activity.

Already on the second day after surgery, the patient begins to be fed using infusion therapy. Daily norm such nutrition is 500-600 ml for every 10 kg of patient weight.

When intestinal motility is restored, the patient is transferred from feeding through the bloodstream to consuming mixtures through a tube in the mouth. When the intestines are completely ready to return to regular food, are introduced into the diet low calorie diet. Most often this happens on the fifth day after the operation.

In addition to nutrition, Special attention V postoperative period it is necessary to pay attention to the condition of the wound. It is necessary to monitor its cleanliness and the degree to which the bandage on the seams gets wet. The condition of the drainage tube should also be monitored. It should not move to avoid disrupting the healing process.

Possible complications

If medical care is not provided in a timely manner, the following complications may occur:

bleeding;
complications in kidney function;
death of intestinal sections.

Complications can also develop during the rehabilitation stage in the postoperative period:

formation of intra-abdominal adhesions;
various intestinal defects that interfere with its normal functioning;
the appearance of a ventral hernia;
the formation of abscesses in the intestines.

Prognosis for peritonitis

Timely diagnosis and operation will not cause problems in the process of postoperative therapy. Timely assistance reduces the likelihood of death from purulent intoxication. If more than two days have passed since the onset of the disease, and help has not yet been provided, death occurs in more than 45% of cases. It is also worth remembering that the patient’s age matters in the course of the disease and rehabilitation after it. Children under 10 years of age and elderly people over 65 require special attention.

If you experience increasing abdominal pain, consult your doctor for a professional diagnosis. It is much easier to cure a disease detected in a timely manner than to save a patient whose chances are almost zero.

Video - Intestinal peritonitis (inflammation of the peritoneum)

Signs of peritonitis always occur severe symptoms, and when acute form pathology can cause serious risks to human health and life. The disease is not classified according to gender and age characteristics, and the appearance of the disease is often due to various predisposing factors. Peritonitis is an area of study in gastroenterology and practical surgery.

Anatomical features of the peritoneum

Features of the pathology

Peritonitis appears to be a widespread (diffuse, diffuse) or local inflammatory process of the serous layer of the peritoneum. Signs of peritonitis are characterized by a severe condition, increased tone muscle structure, problematic stool, gas retention, high fever, symptoms of severe intoxication. During the initial diagnosis of an acute condition, there is often a burdened gastroenterological history, the syndrome “ acute abdomen", other pathological conditions some organs or systems. Treatment of peritonitis is always emergency surgery, which is due not only to the danger of the inflammatory process, but also anatomical structure peritoneal space.

The peritoneum (from the 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 epigastric organs).

Main protective property peritoneum is an opportunity to limit 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 adhesive elements in the structure of the peritoneum, fibrous tissue, cellular and hormonal mechanisms.

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

Symptoms of peritonitis

Main difficulty primary diagnosis peritonitis lies in the similarity of the symptoms of peritonitis and the disease that provokes it. External manifestations of pathology may indicate an exacerbation concomitant diseases gastrointestinal organs, which can be mistakenly perceived by both patients and doctors. This is especially true when chronic forms gastroenterological diseases during periods of exacerbation. Signs of development of peritonitis with acute condition and chronicity of the pathology are different.

Forced body position during peritonitis

General stages of development

The clinical picture of peritonitis depends entirely on the duration of the disease, on the nature of the inflammatory process, on the patient’s age and medical history. 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, general state the patient is seriously ill, there is an expression of obvious suffering on his face. The main features include:

The pain is constant, often localized in the area of inflammation, but there is 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, pain intensifies immediately after moving the hand away from the peritoneum (Shchetkin-Blumberg symptom). Sick of everyone possible ways tries to reduce suffering by adopting a forced body position. The usual poses are on your side or on your back with your legs brought up to your stomach.

Second stage

Second phase ( toxic stage) begins 72 hours after the first signs of peritonitis. Local signs gradually wear off or disappear completely. The patient’s facial features become noticeably sharper, the skin becomes pallor, nail plates turn blue. The extremities become cool or even cold. Patients are in a confused state of mind, showing complete indifference to what is happening (excessive emotional arousal occurs less often). Excitement is common in young children, for whom screaming is the only way to draw attention to pain and suffering. There is occasional loss of consciousness. The abdomen is painless on palpation. Thirst and dry mouth become painful, and constant deep vomiting does not bring any relief. The vomit takes on a dark brown color mixed with blood and has bad smell rotting. Urinary retention is often observed, up to complete loss of urinary function. The temperature reaches 42 degrees, the pulse is barely palpable.

Third stage

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

pale skin with a bluish tint;
sharp facial features;
no pain;
lack of muscle tension in the peritoneum;
breathing problems, even to the point of its absence;
lack of pulse and blood pressure.

In the terminal stage of peritonitis, patients remain in intensive care units and are connected to artificial life support machines. On last stage severe multiple organ failure develops with dysfunction of almost all organs and systems.

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

Peritoneal dialysis or hemodialysis are ineffective. IN laboratory tests blood are detected characteristic features diffuse peritonitis (increased erythrocyte sedimentation rate, pronounced leukocytosis, etc.).

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 as a residual complication after an acute diffuse process. Chronic peritonitis often occurs due to tuberculosis of organs or body systems. Signs of chronic peritonitis are often vague, and it is impossible to determine the exact time of onset of an exacerbation. Typically, the period of exacerbation is determined by the onset of intoxication. TO characteristic symptoms include:

fast fatiguability;
emotional instability;
deterioration in general health;
weight loss;
persistent increase in body temperature;
bowel disorder (diarrhea along with constipation);
severe swelling, pain.

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

Signs of postoperative peritonitis

Postoperative inflammation of the peritoneum is a common complication after surgery in the epigastric region. The main causes are the following:

failure of suture components;
necrosis of gastric tissue;
perforation of ulcerative lesions;
infection during surgery;
insufficient antiseptic treatment after operation.

Widespread localization of pain

Peritonitis after surgery occurs quite often, since with diffuse inflammation it can be 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 the pathology. Against the background of surgery for peritonitis, it is even more difficult to identify the postoperative form from ongoing inflammation. Additional problems in an accurate diagnosis, painkillers, hormones, antibiotics are added, and the patient is already in in serious condition. If the patient has a burdened gastroenterological history, if there is accompanying pathologies organs or systems, it is important to approach any changes in the body with special care.

Important! The outcome of complications depends entirely on the degree of care for patients in the postoperative period, dynamic observation, regular sampling to exclude an increase in endogenous intoxication.

General 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. Among common features highlight:

chills, persistent fever (high or low-grade);
weakness, indifference, apathy;
surges in blood pressure (up to 140 and above mmHg);
sharpening of facial features;
paleness and moisture of the skin;
sleep disorders;
pain of varying intensity.

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

Complications of pathology

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

Peritonitis is a condition of inflammation of the serous membrane (peritoneum) surrounding the internal organs that are located in the abdomen. The name comes from Latin word“peritoneum”, which translates as “peritoneum”, and the suffix “itis” means “inflammation”.

Inflammation of the peritoneum

The disease is severe if treatment is not provided in time. medical care, the outcome may be fatal. What is it and why are the consequences so dangerous?

Causes

Types of peritonitis

If they are divided into groups, then three types of peritonitis can be distinguished:

primary;
secondary;
tertiary.

Primary peritonitis

Inflammation occurs without compromising the integrity of the internal organs, since bacteria enter the peritoneum through the blood or lymph (in women, also through the genitals).

The bacteria that cause peritonitis can be either gram-negative or gram-positive.

In women leading sex life, peritonitis can be caused by gonococci or chlamydia.

Quite rare, but still occurs in such a way that inflammation is caused by Mycobacterium tuberculosis, namely with tuberculosis of the intestines, kidneys, fallopian tubes, other organs.

This type of peritonitis occurs spontaneously in both children (aged 5 to 7 years) and adults.

Develops when the abdominal organs are damaged (stabbed or gunshot wounds) And during the formation of destructive-inflammatory diseases, such as:

appendicitis (inflammation of the appendix);
salpingitis (inflammation of the fallopian tubes);
perforated ulcer duodenum or stomach;
Crohn's disease;
pancreatitis ();
gangrenous cholecystitis (inflammation of the gallbladder);
diverticulitis (inflammation of the intestines);
endometritis in women;
ovarian cyst (during its rupture) and more.

In such cases, bacteria are soon added to the diseases themselves, which help in the development of the process of peritonitis.

If with primary peritonitis they try to eliminate only bacteria from the patient’s peritoneum, then with secondary peritonitis - primary care aimed at speedy healing or removal of the affected organ.

Secondary peritonitis can occur after surgery in the abdominal organs. During surgery, bacteria can enter the patient's body (the same Staphylococcus aureus, which is opportunistic and is present almost everywhere), and the injured body can react violently to this.

Tertiary peritonitis

This species is extremely rare. In fact, this is a relapse of already suffered and cured peritonitis. But when the body is weak and the immune system is not able to fight any difficulties, peritonitis can return. This cannot be prevented, but doctors are obliged to do everything to reduce the risk of recurrence of peritoneal inflammation (taking immunostimulants, antibacterial therapy, etc.).

Classification

Peritonitis can be classified not only by the reasons for its occurrence, but also by a number of other factors:

By etiology:

aseptic or toxic-chemical, without the influence of bacteria, is caused by irritation of the peritoneum with blood or bile, possibly other biological fluids that enter the peritoneum and thereby cause its inflammation;
bacterial peritonitis is caused by microorganisms already familiar to us

According to the duration of the course and the rate of occurrence:

acute inflammation of the peritoneum, the inflammation process occurs in a matter of hours and is either quickly treated or leads to the death of the patient;
chronic, may have a long course with not clearly expressed clinical picture, most often found among pensioners.

By prevalence, which abdominal levels are affected:

limited or local (subhepatic, appendicular, pelvic and many others);
widespread, sometimes general, when the entire abdominal space is affected, local or diffuse with clear localization on one or two floors, and diffuse, when inflammation affects several anatomical areas.

According to which organ or organ system caused the process of inflammation of the peritoneum:

blood – hemorrhagic;
lymph – lymphogenous;
infectious;
postoperative;
post-traumatic.

Symptoms of inflammation of the peritoneum

Peritoneal symptoms occur from the very beginning of inflammation of the peritoneum and worsen as the disease develops if proper medical care is not provided.

Peritonitis can be identified by the following symptoms:

Also, depending on how much the disease has worsened, there are three stages of peritonitis and their characteristic symptoms.

Reactive stage

It is observed during the first day from the onset of inflammation of the peritoneum. Pain appears sharply in the area of the affected organ. Patients usually characterize it as cutting pain sometimes with irradiation to the shoulder blades or to the clavicular area.

The patient has to lie on his side with his legs tucked under him to reduce pain.

Over time, it loses its clear localization and spreads throughout the abdomen. A little later, a period of “imaginary attenuation of pain” begins; in fact, it immediately returns with even greater force.

The patient's abdomen with inflammation of the peritoneum is tight, sometimes retracted, and practically does not participate in the act of breathing.

Positive Shchetkin-Blumberg sign, when pressing on sore spot, the doctor removes his hand, and the pain only intensifies.

Patients have a “Hippocrates face”: pallor and even sallow complexion, sunken eyes, facial features become sharp due to dehydration, cold sweat appears on the forehead, despite the rise in temperature.

During auscultation and percussion, the sound is dull, reminiscent of drumming, and a decrease in intestinal motility or its complete stop is felt.

All these symptoms are called peritoneal syndrome with inflammation of the peritoneum.

The patient also suffers from nausea and vomiting, which does not bring relief due to the fact that it occurs as a result of spasmodic movements of the stomach.

Toxic stage

Coming on the second day from the onset of inflammation. Painful sensations are reduced and peritoneal symptoms become less severe.

But the patient notes: severe intoxication, absence of stool and gases (in in rare cases diarrhea), dehydration, tongue coated with gray coating.

Microcirculation is disrupted, causing the nose, tips of the ears and fingers to turn blue. The patient has a disturbance of consciousness, he is either delirious or remains indifferent to everything. Pulse fluctuates 120 to 140 beats per minute, severe shortness of breath.

Terminal stage

If on the third day no measures are taken and the patient does not improve, then this is reliable sign that death is possible in the near future.

That's why terminal stage often called irreversible. All symptoms of inflammation worsen, dehydration reaches the limit.

Only resuscitation measures, maintaining life with the help of devices and intravenous injections, as well as immediate surgical intervention.

Diagnostics

It is important to establish the diagnosis of peritonitis within the next few hours from the onset of inflammation. It is necessary to establish the causes and find out in which organ the pathological process occurs.

To do this, a number of diagnostic tests and analyzes are used:

examination of the patient, palpation of the abdomen;
taking anamnesis;
study of existing diseases at the time of the onset of inflammation of the peritoneum;
general blood test (with peritonitis, it shows an increase in the number of leukocytes and neutrophils, as well as accelerated erythrocyte sedimentation);
biochemical blood parameters with inflammation of the peritoneum will exceed the norm;
will show the degree of development of peritonitis, which organs are affected and determine the localization of the process;
X-ray examination of the abdominal organs;
performing abdominal puncture (laparocentesis);
laparoscopy (opening the abdominal cavity and sanitation of organs).

Establishing a diagnosis of peritonitis always entails surgical intervention and postoperative sanitation of the patient’s organs.

Treatment

Inflammation of the peritoneum can be fatal if the process is not stopped in time. Therefore, it is important to quickly and correctly prescribe therapy. It consists of preoperative preparation the patient, the operation itself and the course of rehabilitation with intensive care.

Preoperative preparation the patient begins with catheterization of the clavicular vein, as well as Bladder. This is necessary to administer medications and monitor improvement (if there is more urine, it means dehydration is decreasing and the healing process is underway).

Next, remove any remaining food from gastrointestinal tract and reduce the amount gastric juice to a minimum. Because if it gets into the abdominal organs, it can cause a burn. Preparation for anesthesia and administration of antibiotics are carried out. If necessary, ventilation of the lungs, liver and heart function are artificially supported.

Patient photo:

During the operation, the doctor makes an incision from the pubis to the sternum to have access to all abdominal organs. A source of inflammation is located (the affected organ or bacteria), and if possible, the wound is cauterized or sutured, and if not, the organ is removed completely or partially.

Next, the doctor sanitizes the internal organs, washing them repeatedly antiseptics. After this, decompression of the small and large intestines is performed, and drainage is installed to administer antibiotics and eliminate exudate.

The last stage is the application of laporastomy, when the edges of the peritoneum are brought together with special sutures.

Postoperative rehabilitation after peritonitis is aimed at maintaining the patient’s condition, administering 10% glucose intravenously (since the patient is prohibited from drinking and eating for the first two days).

The diet after surgery should include:

liquid soups;
rubbed;
vegetable purees;

Be sure to exclude:

spicy;
salty;
fat;
heavy;
alcohol.

The patient should begin to move around the ward, sit, and stand as early as possible. If the operation is performed correctly and the body responds adequately to all procedures, then there is no need to fear a recurrence of inflammation of the peritoneum.

Prevention inflammation of the peritoneum is not developed, but it is in your power to protect yourself from this by monitoring your health and timely treatment emerging diseases. After all, peritonitis is quite dangerous disease, which it is better not to encounter for adults and children.

– local or diffuse inflammation of the serous covering of the abdominal cavity – the peritoneum. Clinical signs Peritonitis is caused by abdominal pain, muscle tension in the abdominal wall, nausea and vomiting, stool and gas retention, hyperthermia, and severe general condition. Diagnosis of peritonitis is based on medical history, identification of positive peritoneal symptoms, ultrasound data, radiography, vaginal and rectal examinations, laboratory tests. Treatment of peritonitis is always surgical (laparotomy, sanitation of the abdominal cavity) with adequate preoperative and postoperative antibacterial and detoxification therapy.

Changes in general analysis blood during peritonitis (leukocytosis, neutrophilia, increased ESR) indicate purulent intoxication. Laparocentesis (puncture of the abdominal cavity) and diagnostic laparoscopy are indicated in cases that are unclear for diagnosis and allow us to judge the cause and nature of peritonitis.

Treatment of peritonitis

Detection of peritonitis serves as the basis for emergency surgical intervention. Treatment tactics in case of peritonitis, it depends on its cause, however, in all cases, during the operation, the same algorithm is followed: laparotomy is indicated, isolation or removal of the source of peritonitis, intra- and postoperative sanitation of the abdominal cavity, and provision of decompression small intestine.

The surgical approach for peritonitis is a median laparotomy, which provides visualization and reach of all parts of the abdominal cavity. Elimination of the source of peritonitis may include suturing the perforation, appendectomy, colostomy, resection of a necrotic portion of the intestine, etc. All reconstructive interventions are postponed to a later date. late date. For intraoperative sanitation of the abdominal cavity, solutions cooled to +4-6°C are used in a volume of 8-10 liters. Decompression of the small intestine is achieved by inserting a nasogastrointestinal tube (nasointestinal intubation); colon drainage is performed through anus. The operation for peritonitis is completed by installing vinyl chloride drains into the abdominal cavity for aspiration of exudate and intraperitoneal administration of antibiotics.

Postoperative management of patients with peritonitis includes fluid and antibacterial therapy, prescription of immunocorrectors, leukocyte transfusion, intravenous administration ozonated solutions, etc. For antimicrobial therapy of peritonitis, a combination of cephalosporins, aminoglycosides and metronidazole is more often used, providing an effect on the entire range of possible pathogens.

In the treatment of peritonitis, the use of extracorporeal detoxification methods (hemosorption, lymphosorption) is effective. Since most peritonitis is secondary, their prevention requires timely identification and treatment of the underlying pathology - appendicitis, gastric ulcers, pancreatitis, cholecystitis, etc. Prevention of postoperative peritonitis includes adequate hemostasis, sanitation of the abdominal cavity , checking the integrity of anastomoses during abdominal operations.