Peritonitis : causes, symptoms , diagnosis, treatment
Gastroenterology / / May 09, 2016
Peritonitis - is an inflammation (irritation) of the peritoneum, the thin tissue that lines the inside of the abdominal wall and covers most of the abdominal cavity caused by bacterial or fungal infection and accompanied by severe general conditionorganism.
Alternative name peritonitis "acute abdomen".
By the nature of infection or a sharp distinction is made between primary and secondary peritonitis.
Causes and risk factors of peritonitis
Peritonitis caused by hemorrhage, stagnation of body fluids, or intra-abdominal abscess with formation of pus in the abdomen.
The most common risk factors for primary acute peritonitis are:
- Liver diseases, including cirrhosis of the liver.Such diseases often result in the accumulation of peritoneal (ascites) of the liquid, which may become infected.
- Renal failure and receiving peritoneal dialysis to remove waste from the blood of patients with renal insufficiency.This is associated with an increased risk of peritonitis re
most common causes of secondary peritonitis is considered to be:
- Rupture of the appendix, a diverticulum
- Perforation of stomach ulcers or
intestine - Diseases of the digestive tract, such as Crohn's disease and diverticulitis
- Pelvic Inflammatory Disease
- perforation of the stomach, intestinesgallbladder
- surgical operations and procedures in the abdominal cavity
- abdominal injuries, such as stab or gunshot wound
- Gynecological infection of the upper genital tract
- Complications after childbirth and
abortions - The acute intestinal obstruction and
gap - History of peritonitis.After suffering peritonitis risk of developing it again higher than that of those who never had peritonitis.
Non-infectious causes of peritonitis are caused by irritants such as bile, blood, or other foreign substances in the abdominal cavity, for example, barium.
symptoms of peritonitis Peritonitis
begins a sharp pain at the site of organ damage, which quickly intensified especially when moving or clicking on this place.When peritonitis may be a symptom of the so-called "imaginary prosperity" when the patient feels severe pain, which then subsides.At this point, the patient calms down, and it is a very dangerous moment.The fact that the receptors on the peritoneum adaptable, but soon after 1-2 hours pain appears anew as the inflammation of the peritoneum.
Other peritonitis symptoms may include:
- Fever and chills
- Fluid in
abdominal cavity - Symptom SHCHetkina - Blumberg, when abdominal pain increases sharply when the quick release is palpated hands with the anterior abdominal wall after pressing on deep palpation
belly -bloating or feeling of fullness in the
abdominal - muscle tension anterior abdominal wall
- Difficulties with defecation
- Bad carminative
- Excessive fatigue
- Difficult and scanty urination
- Nausea and vomiting, which does not bring relief
- heart palpitations
- Loss of appetite
If you receive peritoneal dialysis, peritonitis symptoms also include:
dialysis fluid - White thread or clots (fibrin) in the dialysis fluid
- Unusual odor dialysis fluid
- Redness of the painful area around the catheter.
Because peritonitis can quickly lead to potentially fatal complications such as sepsis and septic shock, which causes a sharp decrease in blood pressure, organ damage and death, it is important to get a rapid diagnosis and appropriate treatment in the first day.
peritonitis diagnosis begins with a thorough history: symptoms and medical history, and thorough physical examination is necessary, including an assessment of tension and pain in the abdomen.Patients with peritonitis usually lie curled or do not allow anyone to touch her stomach.
diagnostic tests for peritonitis may include:
- Blood and urine tests
- abdominal ultrasound
- abdominal radiography
- Computed tomography (CT) of the abdomen (for the diagnosis of chronic peritonitis)
- Puncture of the abdominalcavity, a procedure in which liquid is removed from the abdominal cavity through a thin needle and assayed for the presence of infection as well as to identify the primary and secondary peritonitis, acute peritonitis caused by pancreatitis.
Treatment of peritonitis
peritonitis Treatment will depend on the reasons which have caused him and the characteristics of its flow.In any case, treatment should be carried out and an emergency hospital.
As a rule, once appointed intravenous antibiotics or antifungal drugs to treat the infection.If necessary the treatment may comprise intravenous fluids and nutrition formulations to maintain blood pressure.After a few days intestinal muscle stimulation is carried out, which can be considerably weakened.
In acute peritonitis, which was caused by the rupture of appendicitis, perforated ulcer, or diverticulitis, emergency surgery is needed and the immediate transfer of the patient to the ICU.The patient is trying to prepare for the surgery to avoid complications, but this possibility is not always there.
During the operation, the pus is removed, held a general reorganization of the abdominal cavity, eliminating the cause of peritonitis - sewn and sealed gaps, excised abscesses.F or a discharge of pus in the newly formed some time set percutaneous drainage.After surgery, continue medical treatment of peritonitis, with the help of the active antibiotic therapy, as well as assigned therapy aimed at maintaining vital functions.
outcome depends on the cause, duration of symptoms before treatment, and the patient's overall health.Results may vary from complete recovery to lethal, depending on these factors.
- Hepatic encephalopathy
syndrome - Sepsis
intestine - Intraperitoneal adhesions
- Septic shock
Prevention of peritonitis
Although peritonitis canbe a complication of peritoneal dialysis is much less common than it once was, due to improvement.
If you receive peritoneal dialysis, you can reduce the risk of peritonitis:
- Wash hands thoroughly, including in the areas between the fingers and under the nails, before touching the catheter.
- Compliance with proper sterility during the procedure.
- Application of an antiseptic cream on the installation site of the catheter every day.
- Immediately report any changes to your dialysis fluid.
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acute purulent peritonitis
Acute peritonitis - an acute inflammation of the peritoneum, requiring emergency medical care, otherwise it can lead to death within a short time.
Acute peritonitis is usually caused by purulent infection, trapped in the abdomen as a result of acute suppurative appendicitis, perforation of the stomach and duodenal ulcers, acute purulent cholecystitis, acute pancreatitis, acute purulent inflammation of the pelvic organs, stomach rupture, bowel, ascites and fluid buildupin the abdominal cavity.
acute purulent peritonitis also occurs in patients who are on peritoneal dialysis for kidney failure.
symptoms of peritonitis are growing rapidly and have several phases of development:
- reactive phase, which lasts from 12 to 24 hours, accompanied by acute pain, extending to the entire abdomen, with the peak of morbidity in the primary tumor area.The abdomen is tense, there is a symptom Shchetkina-Blumberg.The patient lies in the "fetal position" on the side with legs given to the stomach, any attempt to change the posture increases the pain.This condition is accompanied by fever and chills.
- Toxic phase, which lasts from 12 to 72 hours, is dangerous because it comes apparent improvement.The pain subsides, the stomach ceases to be busy, the patient enters a state of lethargy or euphoria.The facial features of his sharpened, appears pale, there is nausea and vomiting, which accepts the painful debilitating character and does not bring relief.Reduced urination and intestinal peristalsis, while listening to can not hear normal bowel sounds.They begin to appear the first symptoms of dehydration, such as dry mouth, but fluid intake is difficult because of the lethargy or vomiting.About 20% of patients die in this stage.
- Terminal phase occurs from 24 to 72 hours from the onset of the disease and lasts several hours.At this stage, there is a profound disorder of the functions of all systems of the body, the body's defenses are depleted.The patient is in prostration, indifferent to what is happening.A person acquires an earthy tone, eyes and cheeks sink, there is a so-called "Hippocratic mask" serves cold sweat.Can profuse vomiting putrid contents of the small intestine.Appears shortness of breath and tachycardia, body temperature drops rapidly, and in the terminal stage, it is often below 36 C. The abdomen is swollen, painful, but there is no protective tension of muscles.In end-stage die about 90% of patients.
Thus, acute peritonitis can be fatal within 24 hours of onset.
Treatment of acute purulent peritonitis
purulent peritonitis is an absolute indication for surgery aimed at removing the source of infection or distinguishing it with the adequate drainage.
During surgery removes the damaged tissue, the abdominal cavity is washed with antibacterial drugs.The next stage of treatment is to combat the paralytic ileus, correction of fluid and electrolyte balance, protein metabolism via infusion therapy, as well as correction and normalization of the kidneys, liver, heart and lungs.
success of treatment for acute purulent peritonitis depends on the velocity of circulation of medical care and treatment is urgently begun.