Peritonitis

Published: 09/24/2021 12:05:00 Updated: 09/24/2021

Peritonitis is an inflammatory lesion of the peritoneum, the serous membrane covering most of the internal organs and lining the walls of the abdominal cavity from the inside. In most cases, it occurs as a complication of infectious and inflammatory diseases or injuries in the chest and abdomen. The patient's condition is often severe, with intense abdominal pain, vomiting, fever and other symptoms. Treatment is aimed at combating the infectious pathogen, most often of bacterial origin, and always includes abdominal surgery.

The peritoneum performs several important functions:

regulates the volume and composition of fluid filling the abdominal cavity;
provides mechanical and immune protection of internal organs;
limits the source of infection due to the formation of adhesions, preventing the spread of the pathogen throughout the body.

Its inflammation leads to disruption of vital organs and the development of adverse pathophysiological reactions that are dangerous to humans.

Causes

Typically, inflammation of the peritoneum is caused by a bacterial infection.
Often these are representatives of the normal microflora of the digestive system - enterobacteria, E. coli, Proteus, cocci, clostridia and other microorganisms. Less commonly, pathogens include gonorrhea, tuberculosis, hemolytic streptococcus or pneumococcus. Depending on the route of penetration of the pathogen into the abdominal cavity, three types of pathology are distinguished. Primary peritonitis develops when the pathogen migrates from other foci of inflammation along the bloodstream, fallopian tubes in women, or with the lymph flow. This is possible with diseases of the pelvic organs, including gynecological diseases, inflammation in the gastrointestinal tract, and infectious kidney lesions.

Secondary peritonitis is not an independent disease, but a complication of destructive and inflammatory lesions of the abdominal organs. Peritonitis can also be caused by penetrating injury to the abdominal wall or blunt trauma to the abdomen with rupture of internal organs, postoperative complications and errors during surgical interventions. Separately, it is worth noting inflammatory lesions of the peritoneum due to malignant tumors, helminthic infestation, granulomatous and rheumatoid processes in the body.

Tertiary peritonitis occurs two days after removal of the focus of secondary peritonitis. The reason for its appearance is that the patient’s body was unable to form an adequate response to the infectious process.

Primary peritonitis

Primary pelvioperitonitis is said to occur when pathogenic microorganisms penetrate the small pelvis directly - during gynecological operations and manipulations (surgical abortion, curettage, blowing of the fallopian tubes, etc.). Most often, it is associated with unsanitary conditions, violation of the rules for performing the operation, the use of reusable instruments, etc. For this reason, it is important to seek treatment in reliable modern clinics, where sterility standards are strictly monitored, and professional surgeons will not allow complications.

Classification

Peritonitis is of the following types:

bacterial – caused by microbial flora;
abacterial - with aseptic or toxic-chemical inflammation of the peritoneum due to its irritation by aggressive non-infected fluids (blood, digestive enzymes and secretions of internal organs, urine);
special forms - parasitic, rheumatoid, carcinomatous and granulomatous.

According to the course of the disease, peritonitis is divided into acute and chronic.
According to the area of the affected peritoneum, inflammation can be limited, local (with damage to 1-2 anatomical areas), diffuse (covering three or more areas) and general (with total inflammation).

In its development, the disease goes through an early phase (less than twelve hours), late (less than five days) and final (from one to three weeks from the onset of inflammation).

Symptoms

Acute peritonitis occurs in three stages, each of which has its own manifestations.
On the first day from the onset of peritonitis, in the reactive stage, a local reaction to irritation of the peritoneum is noted. Initially, pain is localized where the source of inflammation is located, and can radiate to the shoulder, under the collarbone. Subsequently, the pain spreads throughout the abdomen. To alleviate the condition, a person assumes the “embryo” position, lying with his legs pressed to his stomach. The patient is concerned about dry mouth, nausea and vomiting, and loss of appetite. The toxic stage develops between four and seventy-eight hours. Characterized by increasing intoxication up to endotoxic shock, increased general manifestations - blood pressure decreases, heart rate increases, body temperature rises and breathing problems appear. The pain is diffuse in nature, its intensity decreases, as paralysis of the nerve endings of the peritoneum begins, bloating and constipation are noted.

In the terminal stage, after seventy-two hours from the onset of inflammation of the peritoneum, a gross disruption of vital processes inside the body occurs. The symptoms of peritonitis are dominated by manifestations of paralytic intestinal obstruction - intense abdominal pain, severe vomiting that does not bring relief, and severe bloating. The patient's condition is extremely serious, facial features are sharpened, blood pressure is sharply reduced, urine does not pass, consciousness is confused, limbs acquire a bluish or yellow tint, increased sweating and other signs of multiple organ failure are characteristic.

Chronic peritonitis is characterized by “blurred” symptoms that arise as a result of prolonged intoxication and the formation of adhesions in the abdominal cavity, disrupting the functioning of internal organs.

Pathology manifests itself:

lack of appetite and weight loss;
increased sweating;
persistent low-grade fever up to 37.5 °C;
bowel dysfunction;
periodic abdominal pain and bloating.

Adhesions and dense scar cords make it difficult to empty the hollow organs, which is accompanied by dyspeptic symptoms - nausea, vomiting, flatulence, urination and menstrual disorders.

Complications

Peritonitis in children and adults is dangerous due to the development of multiple organ failure and intoxication of the body. Among the complications of the acute process:

dehydration;
renal failure;
toxic shock;
pulmonary pathologies;
liver failure;
secondary inflammatory processes.

Peritonitis after surgery may be accompanied by the formation of fistulas and abscesses of internal organs, and suppuration of postoperative sutures. The appearance of a number of complications is possible far beyond the abdominal cavity - occlusion of deep veins, inflammation of the lungs and pleura, mediastinitis.

Etiology of bacteria and abacteria (aseptic, chemical) peritonitis. Songs of aggressiveness emes infectionlyak agenttermen peritoneals titirkenu natizhesinde payda bolada (ot, kan arkyly, askazan shyryn, asqazan shyryn, nesep, Chyle suyiktyk). Bacterialyk peritonitis is also associated with the microbigotyn tabigatyna otete tes tusedi.

Peritoneals efusitis tabigatina baylanysty serozda azhyratadas, fibrinosdes, hemorrhages, gallium, irons, feces, wide peritonitis.

Klinikalyk kurska saikes peritonitis zhedel zhane sozylmaly bolinedi. Peritonny betinde zakimdanudyn taraluyn eskere otyrup, bolinedi (zhergiliktі) zhane diffusion peritonitis. Zhergіlіktі peritonitis núskalary ushіn subfrenta kamtida, kosymsha, subpepatikalyk, ishіlіk ishek, zhambas abscesses. Diffusion peritonitis turals, peritonny kabynuy kezinde shekaralardy shekteu zhane tazalau urdisi zhok. Peritoneal ducts, diffusion, peritonitis, gergillicity, dengue, pain (before the anatomy of the dams, infection of the body), stings (before the anatomy of the dams) Not ortak (peritonic stings are closed).

Peritonitis damuynda erte kezenda bolu ushіn kabyldanady (12 sagatka deyin), keshikpey (3-5 kunge deyin) zhane korytyndy (aurudyn bastaluynan 6-dan 21 kunge deyin). Pathogenetics өzgerіsterge sәikes reaktti azhyratylady, peritonitis uly zhane terminaldyk satylary. Peritonitis reaction; wasps kezende zhergilikti korinister en aikyn korinedi zhane zhalpy symptomdar az korinedi. Peritonitis ul satysy (4-ten 72 sagatka deyin) mask nemdiktin artuymen sipattalada (endotoksikalyk shock), ortak reactionlardyn taraluy zhan taraluy. Peritonitis terminaldyk kezeninde (72 sagattan kein) korgaushy-compensatorlyk tetikterdin tausyluy oryn alada, denenin omirlik functionlaryn teren byzylystary damidy.

Sonday-ak okynyz Laryngtic tuberculosis

Diagnostics

If, during a conversation with the patient and examination, the doctor suspects peritonitis in an adult or child, the patient is urgently hospitalized in a hospital inpatient unit, where further laboratory and instrumental studies are carried out to clarify the diagnosis.
The list of tests for peritonitis includes:

Clinical blood test. During the purulent process, an increase in the number of leukocytes is determined, accelerated ESR, and the hematocrit changes.
Biochemical blood test to determine indicators such as C-reactive protein, aspartate aminotransferase, alanine aminotransferase, total bilirubin, blood sugar, creatinine, lactate dehydrogenase, amylase, lipase, procalcitonin, interleukins 1, 6, 8, 10, tumor necrosis factor, urea, total protein and albumin.
Hemostasis indicators, fibrinogen concentration, prothrombin time, INR, APTT.
Content of electrolytes in the blood.
General urine analysis.

Instrumental diagnosis of peritonitis consists of ultrasound and survey R-graphy of the abdominal organs, electrocardiography, magnetic resonance and computed tomography. In complex clinical cases, to clarify the nature of the causative agent of the disease and confirm peritonitis, abdominal puncture, bacteriological examination of peritoneal exudate and laparoscopy are performed.

Peritonitis sebeptera

Peritonitis etiology is a bacterial infection, as a result of microflora. Olar Gram-teris boluy mumkin (enterobacter, E. coli, protein, Pseudomonas aeruginosa) and gram-positive (staphylococcus, streptococcus) aerobtar; Gram-teris (fusobacterium, bacteroidter) and gram-positive (eubacteria, Clostridiums, peptococci) anaerobic. B 60-80% peritonitis microtardyn association simon baylanysty – E. coli and Staphylococcus live everywhere. Living, peritonitis ladies, bir microfloramen baylanysts - gonococcus, hemolytic streptococcus, pneumococcus, Mycobacterium tuberculosis. Sondyktan, peritonitis ұtymdy emіn tandau ushіn, іsh қуысынѣ мазмұнн bacteriological inoculation laу tandalgan microflora bacterium karsy drugtarga sezіmtaldygyn anћtaumen birge ote manyzdy.

Etilogy of sikes bastapkyda ayirmashylyk bar (idiopathical) and peritonitis. Bastaky peritonitis is a result of the lymphogenid microflora synergy, hematogendik nemes fallopiyalyk tutikter. Peritoneal tissues in case of salphingitis pen baylanysty bolu mumkin, enterocolitis, beurek nemes zhynys mushelerinіn tuberculosis. Bastapky peritonitis live everywhere – 1-1.5% ester.

Sonday-ak okynyz Folliculars Kalkansha Raga

The clinic will also be in charge of peritonitis and peritonitis, as soon as the aurulars are out of place. Kobinese peritonitis appendicitis zholyn qiyndatady (perforation of the langan, phlegmonosis, gangrenosis), askazan asty nemese ultabar oyyk heat, pyrosalpins, obyr cystalaryn zharyluy, ishek toskauyldary, black kamau, mesenteric tamyrlardyn otkіr occlusions, Crohn's aura, diverticulitis, phlegmonasis grangranozdyk cholecystitis, pancreatitis, uyky bezіnіn necrosis etc. aurular.

Post-traumatic peritonitis іш қуысынн захық zәне ашық зрахақаттары салдирянн damida. Surgery for keying peritonitis of the sepsis at the anastomosis of the sacral tissue, ligation of the sepsis, peritonous mechanics of the circuit, repair and further operation sy, hemostosis zhetkiliksizdig. As a result, there are diseases, parasites, granulomatosis, rheumatoid peritonitis.

Treatment

Treatment of peritonitis is always surgical, with mandatory preoperative drug preparation.
The latter is aimed at replenishing the balance of fluids, salts and normalizing the patient’s condition, as well as adequate pain relief and normalizing blood pressure. During surgery for peritonitis, the source of infection is eliminated, pus and peritoneal effusion are removed, the abdominal cavity is washed with antiseptic solutions and drained. Postoperative management of the patient includes a course of powerful antibiotic therapy, drips with detoxification solutions, medications to support the functioning of the cardiovascular system, respiratory system and nervous system.

Author:

Pugonina Tatyana Alekseevna, Therapist

Peritonitis aldyn-alu zane aldyn-alu

Peritonitis is a serious and unimportant operation. Diffusion peritonitis kezinde olim 40 zhaska zhetedi% zhane baskalar; The science of science and technology is important.

Koptegen peritonitis kaytalama bolgandyktan, olardyn aldyn alu negіzgі pathologies der kezinde anyktaudy zhane emdeudі talap edi - appendicitis, askazan zharasy, pancreatitis, cholecystitis zhene etc. The operation was carried out for the keying of peritonitis and ulceration of the hemostasis bar, as well as advanced sanitation, and performed operations on the anastomosis of the texer.