What does high voltage ecg mean. Early signs of the disease

The peritoneum is a shell in the form of two sheets. The spaces they form contain serous fluid. The main function of the peritoneum is the creation of partitions between the internal organs and muscles, as well as fixation in a suspended state with the help of mesentery and ligaments. The peritoneum protects the internal organs in yet another way. When it encounters microbes, substances are produced that lead to the death of harmful microorganisms. Peritonitis - inflammation of the peritoneum, leading to disruption of all systems and organs located in this area, what are the symptoms of the pathology?

Peritonitis - inflammation of the peritoneum

Peritonitis begins to develop when the peritoneum cannot cope with the huge number of invading and multiplying microbes. In this situation, the peritoneum becomes a source that spreads the infection. This disease is life threatening and can end sadly if adequate measures are not taken to localize the inflammation and normalize the condition.

The introduction and spread of infection in the abdominal cavity most often develops as a result of trauma to the organs of this area, a violation of their integrity. The cause may be a disease of the internal organs. Occasionally, peritonitis can develop when microorganisms are brought into this area by blood or lymph.

In most cases, peritonitis does not occur as an independent disease, but as a complication of diseases of the abdominal organs. For example, appendicitis, intestinal obstruction, as well as duodenal ulcers, in case of untimely measures taken, end in peritonitis. The destruction of the organ after the collapse of the tumor leads to inflammation of the peritoneum. The necrosis of a fragment of the intestine during a hernia, trauma to the abdominal cavity, accompanied by injury, rupture of the organ, partial destruction of the wall of the stomach or intestines by a foreign body can also result in peritonitis.

Sometimes, with heart disease, fluid accumulates in the abdominal cavity, which suppurates in the event of an unfavorable development of events. This becomes another cause of peritonitis.

Not all types of peritonitis are caused by pathogens. For example, getting into the abdominal cavity of blood due to violation of the integrity of the vessel also leads to peritonitis. In this case, the type of disease is called aseptic or non-microbial. The disease at this level lasts no more than 6 hours. After this period, microbes from the intestinal zone penetrate into the hematoma. After that, peritonitis becomes normal.

Signs of peritonitis

Manifestations of peritonitis are due to the reasons that provoked its development. But the main features of this or that stage coincide in any case.

Reactive stage

This is the first stage, it takes the first day of the course of the disease. The damage is local. Patients first feel sharp pains that appear unexpectedly. In this case, you can accurately determine the place where the pain comes from. Some compare the pain at this stage with a dagger strike.

Localization of pain is associated with the organ that became the source of the development of the disease. For example, with appendicitis, pain will be felt in the lower lateral zone on the right. If this is a perforation of a stomach ulcer, then the pain will appear in the hypochondrium on the left or. The pain is felt strongly, while it gradually spreads.

Sometimes there are periods when the pain seems to subside. But this is not for long. Relief lasts no more than 2 - 3 hours. Then everything escalates.

The patient has a rather characteristic appearance:

pale skin, bluish tint;
cold sweat;
suffering expression.

Pain greatly disturbs a person, he, as a rule, tries to alleviate their intensity by taking certain postures. For example, lie on your side and tuck your knees, do not cough, do not inflate your stomach.

A characteristic symptom of peritonitis is a disc-shaped abdomen. This symptom is expressed in an overly tense abdomen. His feeling is very painful. To check for peritonitis, you can apply the Shchetkin-Blumberg method: press on the abdomen, and then quickly remove your hand.

Also typical signs will be false urge to defecate or urinate, repeated vomiting many times. Other signs that are considered symptoms of peritonitis indicate intoxication of the body. This is an increase in temperature, rapid pulse, dry mouth, intense thirst.

toxic

This is the second stage. During this period, the person is in a serious condition. All signs indicating the presence of poisoning are manifested. This stage takes about two days, begins 24 hours after the onset of the disease. Symptoms of the first stage are smoothed out. The muscles of the abdominal wall are slightly tense, they can generally be normal. Pain sensations are not strong, blurry. The appearance of a person at the moment also has common typical features:

pale lips;
cold extremities;
bluish nose, ears, nails.

Dry mouth persists, consciousness may be disturbed. This is expressed in complete indifference, less often in excitement. The patient may lose consciousness. The patient lies without moving. Doesn't respond to palpation. persists, only the vomit acquires a different color. They become dark, brown, fetid. Little or no urine. The temperature rises to very high figures: 40 - 42 °. Breathing becomes unstable, the pulse is very weak.

Terminal stage (irreversible)

This is the third stage, it comes three days after the onset of the disease. After three, and sometimes even after two days, it ends with the death of the patient. The condition can be classified as extremely serious. The appearance of all patients in this situation is the same. This complex of external manifestations is called the "face of Hippocrates":

cyanotic moist skin;
sunken cheeks;
overly sharp features.

The abdomen is soft, there is no pain at all, palpation does not cause discomfort. The pulse is not palpable, breathing is weak, may be completely absent, pressure is not determined. Human life at this stage is possible only in intensive care with the use of artificial life support systems.

Diagnosis of peritonitis

If peritonitis has developed in a confined space, as occurs in encysted peritonitis, it can be difficult to make a diagnosis. Ulcers that are a consequence of laparotomy interventions (subdiaphragmatic, interloop, pelvic, abscesses, ulcers of the right iliac fossa) also have diagnostic difficulties.

With sluggish processes, the disease can manifest itself as short-term pain sensations, which are replaced by general malaise. Anemia, exhaustion, a person may develop a fever. There are no local signs, so the doctor may consider that an infection has settled in the body or a tumor process is going on somewhere.

It is very difficult to identify this type of peritonitis. It is necessary to conduct a comprehensive examination, including many tests, vaginal, rectal examinations. Of course, such a diagnosis is best done in a hospital. The diagnosis can be made by analyzing the entire clinical picture. Attention is paid to whether there is intoxication, and, of course, to the condition of the peritoneum. To make sure the diagnosis is correct, use the result of radiography, laparoscopy.

If the patient is suspected of local or diffuse peritonitis, he is urgently sent to the hospital.

You should not give drugs to eliminate pain, because this greatly changes the picture of what is happening. Then in the hospital it may be difficult to make a diagnosis. To alleviate the condition, an ice pack is placed on the stomach. Polyglucin is administered intravenously. It will help to avoid severe dehydration and infectious-toxic shock. It is necessary to inject the drug drip. Quantity 400 - 800 ml. glucose (5%) or sodium chloride is also administered. These drugs facilitate the general condition of the patient, create safer conditions for transportation, and serve as some preparation for the upcoming operation.

Treatment of peritonitis

If the diagnosis is established, an emergency operation is performed. During the operation, they act according to the circumstances. After examining all tissues, the affected areas of organs are sutured, tumors are removed, and bleeding is stopped. Existing purulent foci are brought back to normal, they are washed with antiseptic solutions. It is advisable to use Ringer's solution.

If inflammation has affected significant areas, then washing is carried out for several days. After the operation is administered in large quantities. Also direct actions to eliminate dehydration.

The famous surgeon S. I. Spasokukotsky noted back in 1926 that if the operation was performed in the first hours after the development of inflammation, then 90% of patients recover. The operation during the first day gives recovery in 50% of cases. And only 10% have a chance to survive if the operation is done later than the third day.

In our time, approximately the same trend continues. Surgical intervention on the first day ends with recovery. At the second stage, the success of treatment is already doubtful. Recovery occurs if the organs and systems are not severely affected. At the third stage, it is not possible to correct the condition, because irreparable changes occur with the internal organs.

Preventive actions

Prevention of this disease is to inform people about. Only people who have knowledge about the stages of this disease and about its other features can take adequate measures in time and avoid the sad part.

Video material for the curious, but not for the faint of heart. Surgical complications. Relaparoscopy for biliary peritonitis:

Tell your friends! Share this article with your friends on your favorite social network using the social buttons. Thank you!

Along with this article read:

Peritonitis - this is inflammation of the parietal and visceral peritoneum, as a rule, of a secondary nature, accompanied by a syndrome of intoxication, which leads to disruption of the activity of all organs and systems - multiple organ failure.

Frequency - 5,5 on the 100000
Complicates 4,3 – 20,5% all acute surgical and gynecological diseases
Lethality - 20 — 30%

Anatomical features of the structure of the peritoneum

The peritoneum is covered with a layer of polygonal flat cells called mesothelium. It is followed by the boundary (basement) membrane, then the superficial fibrous collagen layer, the elastic (superficial and deep) network, and the deep cribriform collagen layer. The last layer is the most developed and occupies more than half of the entire thickness of the peritoneum, it is here that the peritoneum is abundantly penetrated by a rich network of lymphatic and blood vessels.

The peritoneum consists of parietal and visceral sheets, which are a single continuous shell. The visceral layer covers the organs, the parietal layer lines the inside of the anterior and posterior walls of the abdomen, the walls of the small pelvis. The parietal sheet of the peritoneum is rich in endings of sensory nerves, it reacts with pain to any irritation: chemical, thermal, mechanical. Pain is always localized. But their number is not the same - there are more nerve endings in the upper floor, and noticeably less in the pelvis. This is of great clinical importance - for example, the accumulation of purulent effusion under the right dome of the diaphragm causes sharp pains radiating to the shoulder and neck (phrenicus symptom), and the accumulation of effusion in the small pelvis can be almost asymptomatic.

But the visceral sheet of the peritoneum is almost not sensitive, therefore, irritation of the organs from the outside is not of a painful nature. On the other hand, stretching of the internal organs and the peritoneum covering them (for example, with intestinal obstruction) leads to sharp pains, which are called visceral.

CLASSIFICATION OF PERITONITIS.

BY THE NATURE OF PENETRATION OF THE INFECTION

Primary peritonitis, (1-3%). Occurs without violation of the integrity or inflammation of the abdominal organs and is the result of spontaneous hematogenous introduction of infection into the abdominal cavity from other organs. For example, this is pneumococcal peritonitis in children (the drift of pneumococci from the lungs with pneumonia). As a rule, this is a monoinfection.
secondary peritonitis, occurs most frequently. Its cause is perforation or inflammation of the abdominal organs, trauma (open and closed) of the abdominal organs, postoperative peritonitis. For example, peritonitis in acute gangrenous appendicitis, perforated ulcer, necrosis of the intestine during its volvulus, etc.
Tertiary peritonitis. It is also called: sluggish, recurrent, persistent, recurrent. This is a protracted course of peritonitis in debilitated patients. The patient does not die for several weeks, but he cannot recover either, the clinical picture is erased, the reaction from the peritoneum decreases, but does not go away at all. It develops in various forms of impaired immunity, in HIV-infected patients, in malnourished patients, in patients with intestinal fistulas, with concomitant diseases (tuberculosis, diabetes mellitus, SLE, etc.).

NATURE OF PATHOLOGICAL AGENT AND SPECIFIC INFECTION:

Biliary peritonitis
Enzymatic (pancreatic enzymes) peritonitis
urinary peritonitis
Fecal peritonitis
Hemorrhagic peritonitis
colibacillary peritonitis
Specific forms of peritonitis: Syphilitic, Tuberculous, Candidomycosis, Carcinomatous, etc.

All peritonitis from 1. to 6. despite a different cause, proceed according to a single law. If at first they have a different clinical picture, then in the end they all end with a purulent-fibrinous process, severe intoxication, multiple organ failure and, in the absence of adequate surgical treatment, the death of the patient.

The course of specific peritonitis (7) proceeds depending on the type of infection, almost all of them are chronic, require the appointment of specific drugs (for example, anti-tuberculosis), and surgery is usually not needed.

BY THE PREVALENCE OF THE PROCESS (according to Fedorov V.D.).

This classification is important for determining the timing of peritonitis and its severity, and also determines the choice of surgery and postoperative management.

one). Local:

A. Local limited peritonitis are abdominal abscesses. Hence, each abscess of the abdominal cavity must be considered as peritonitis, albeit limited and possibly small in area, but proceeding according to all the laws of peritonitis.

B. Local unlimited peritonitis, this is peritonitis, frolicking in only one anatomical region and having no reason for limitation. Usually he just did not have time spread throughout the abdomen. For example, a patient had a perforation of the appendix, but he was immediately operated on.

2). Common

A. Diffuse peritonitis, this is peritonitis, covering a significant part of the abdominal cavity (1 or 2 floors of the abdominal cavity, but not all). For example, a patient was admitted with a perforation of the appendix, during the operation he was found to have pus in both iliac regions, he reached the navel and above, but the upper floor of the abdominal cavity remained free - such peritonitis will be considered diffuse. It should be noted that in other classifications the word "diffuse" may have a different meaning, for example, be a synonym for the word spilled.

B. Diffuse peritonitis, This is peritonitis covering all three floors of the abdominal cavity

B. General peritonitis or total, essentially the same as diffuse peritonitis, but emphasizing the totality of the lesion of the abdominal cavity. At present, this term is almost never used.

Recently, proposals have been considered to simplify this classification and divide it into only two forms (Saveliev V.S., Eryukhin E.A. 2009): 1. Local peritonitis; 2 Widespread (diffuse) peritonitis.

BY NATURE

Serous peritonitis. Indicates short periods of inflammation. In the abdominal cavity there is a transparent light effusion, odorless, light yellow or yellow effusion. The amount may be small or significant.
Serous fibrinous peritonitis. White fibrin clots appear, they float in the effusion, or are located on the peritoneum. Usually there are more of them where the source of inflammation is located. They are easy to remove or wash away from the intestinal wall or peritoneum.
Purulent peritonitis. The exudate turns into pus, thickens, becomes opaque. Pus in the abdominal cavity usually sooner or later becomes colibacillary (Gr-) and differs from those abscesses that we see in soft tissues (cocci, Gr +), where the pus is usually creamy. In the abdominal cavity, purulent effusion is liquid, dirty gray in color, with spots of fat. Gradually, a sharp specific smell appears.
Purulent-fibrinous peritonitis. Not only does a large amount of pus and fibrin appear in the abdominal cavity, but the latter begins to cover large areas of the peritoneum. Fibrin penetrates deep into the walls of organs and it is not possible to simply remove it from the walls of the intestines, if you make an effort, then the peritoneum will be torn off with fibrin up to the muscle layer. Fibrin, richly covered with infection, glues intestinal loops into extensive conglomerates in the center of which abscesses form.

One of the important classifications of peritonitis, this classification according to STAGES (according to Simonyan K.S.).

It primarily reflects pathophysiological changes in the body, depending on the stage of the process, as well as those associated with these processes clinical manifestations.

This classification assumes three stages of pathophysiological changes occurring in the body. It is based on the relationship of protective (immune) forces and the forces of infection in the abdominal cavity. With the gradual depletion of the body's immune properties and damage to internal organs due to intoxication, one stage of peritonitis passes into another. The division into stages by time (24, 24-72 hours, 72 hours or more) is approximate and conditional. Depending on the individual characteristics of the organism, the presence of concomitant immune-depressive diseases (diabetes, HIV, tuberculosis), as well as on the characteristics of the infection, these terms can vary significantly in both directions.

Reactive stage (24 hours)

Local and general reaction of the body to infection in the abdominal cavity. It is manifested by a violent protective reaction of the body to infection. From the side of the peritoneum: hyperemia, increased vascular permeability, exudation, formation of fibrin films, gluing of the intestines. Gradual transformation of serous effusion into purulent.

General reaction: nonspecific inflammatory hypothalamic-pituitary-adrenal reaction, intoxication with exo and endotoxins. Hormones (GCS), catecholamines and microbial toxins stimulate the production of interleukins. But despite the intoxication, all organs and systems cope with their function. If the operation is performed within 24 hours and the source of peritonitis is removed, the body copes with the infection and recovery occurs.

Clinically the patient complains of very severe pain in the abdomen, possibly a forced position (posture of the "embryo" with a perforated ulcer). Intoxication appears and grows: fever to subfibril numbers, tachycardia, tachypnea, dry mouth. Sometimes vomiting. Leukocytosis and a shift of the leukoformula to the left appear in the blood, mainly due to an increase in the stab forms of neutrophils by more than 5.

When examining the abdomen: the latter partially or completely does not take part in breathing. In any area or throughout the abdomen, there is pain, muscle tension of the anterior abdominal wall (rigidity, defense), positive symptoms of peritoneal irritation (Shchetkin-Blumberg symptom, Mendel symptom - tapping with the fingertips), soreness of the pelvic peritoneum during rectal or vaginal examination.

Mortality for this stage is not typical and does not exceed 3%.

Toxic stage (24-72 hours).

Depletion of the protective and compensatory forces of the body, a breakthrough of biological barriers that restrain endogenous intoxication (these primarily include the liver, peritoneum, intestinal wall). Severe intoxication with exo- and endotoxins, interleukins, and cell destruction products leads to damage to all organs and systems and the development of multiple organ failure, which is initially reversible (multiorgan dysfunction).

If you perform an operation at this stage, one removal of the source of peritonitis may not be enough. Treatment of the disease requires a set of measures to drain the abdominal cavity, suppress infection with antibiotics, correct intoxication and water-electrolyte disorders, etc. During active therapeutic measures, disturbances in the activity of all organs gradually disappear, and the body copes with the infection.

Clinically: Severe condition. Usually any peritonitis in this stage is diffuse. Dry tongue (like a brush), dry lips, vomiting. The muscles of the anterior abdominal wall are tense, positive symptoms of peritoneal irritation. Percussion (and ultrasound) can determine the effusion in the sloping areas of the abdominal cavity.

A detailed picture of intoxication. "The face of Hippocrates" haggard, with sunken eyes. The patient is adynamic and his posture expresses, as it were, impotence. The pulse is frequent, weak, arterial pressure decreases, the temperature is hectic, breathing is frequent, free, noisy.

Multiple organ failure manifests itself as oliguria, intestinal paresis (deathly silence, bloating), impaired consciousness (stupor or euphoria). In the blood, leukocytosis, a shift of the formula to the left to young forms and myelocytes.

Lethality reaches 20%.

Terminal stage (over 72 hours).

In the absence of surgery, purulent effusion spreads throughout the abdominal cavity. Fibrin, which has absorbed a large amount of infection on itself, covers the parietal and visceral peritoneum, the intestinal walls stick together with the formation of infiltrates, in which interloop abscesses are born. The waste products of microorganisms, the products of cell decay are absorbed into the blood, causing severe intoxication. Local and general defense mechanisms are completely untenable. Septic shock may develop. After 72 hours, intoxication and hypoxia lead to the development of severe damage to all organs and systems, their severe hypoxia occurs. The changes that result from this in the internal organs are severe dystrophic and irreversible character(hyalinosis, amyloidosis of cardiomyocytes, hepatocytes, necrosis of the epithelium of the renal tubules, etc.). There is renal failure, shock lung, impaired (CNS), consciousness, destruction of immunity, toxic damage to the liver, depression of cardiac activity, which ultimately leads to the death of the patient.

One of the manifestations of multiple organ failure is severe intestinal paresis. Despite the fact that it remains physically sealed, in the conditions of the terminal stage of peritonitis it becomes permeable to gram-intestinal microflora, which in large quantities freely enters the abdominal cavity from the intestinal lumen.

Clinically the terminal phase of peritonitis manifests itself as signs of severe intoxication + severe multiple organ failure. The condition is extremely difficult. The face of Hippocrates. Adynamia, prostration, psychosis, coma. Vomiting with a fecal odor is possible. Tachycardia, thready pulse, decreased blood pressure. Decreased diuresis or oliguria. Respiratory depression, decreased suturation (blood oxygen levels indicated by bedside monitors). To maintain life and raise blood pressure, such patients are often transferred to inotropic support (constant intravenous administration of dopamine), to improve respiratory function, patients are transferred to mechanical ventilation.

The abdomen is painful, bloating, with auscultation "deathly silence", while muscle tension is not expressed.

In the blood, a sharp shift in the formula to the left: a large number of young forms and myelocytes, the number of stab neutrophils is 15-30 units, hyperleukocytosis, which in some cases can be replaced by leukopenia

Principles of treatment of peritonitis

early hospitalization;
Early surgery including:
- elimination of sources of peritonitis;
- thorough sanitation of the abdominal cavity;
- drainage of the abdominal cavity;
- according to indications - decompression of the small intestine;
Complex intensive postoperative therapy, including:
- rational antibiotic therapy;
- detox therapy;
- correction of homeostasis disorders;
- treatment and prevention of enteral insufficiency.

Surgery

Preoperative preparation The indication is the severity of the physical condition, exceeding the value of 12 points on the APACHE II scale.

The preparation time for the operation should not exceed 1.5-2 hours.

The general scheme of preoperative preparation, along with generally accepted hygienic measures, includes: catheterization of the central vein, bladder, stomach - the rule of "three catheters"; jet (with cardiopulmonary insufficiency - drip) intravenous administration of low-concentrated polyionic crystalloid solutions in a volume of up to 1000-1500 ml; transfusion of 400-500 ml of colloidal solutions to replenish the volume of circulating fluid; correction of hemodynamics and oxygen transport; intravenous use of broad-spectrum antibiotics.

The need for intravenous antibiotics in the preoperative period is determined by the inevitable mechanical destruction during surgical intervention of biological barriers that delimit the area of the infectious process. Therefore, the operation should be performed against the background of creating a therapeutic concentration of antibacterial drugs in the blood and tissues, which for most of them is achieved 30-60 minutes after intravenous administration. It is practically impossible to carry out a complete correction of homeostasis disorders before surgery; it is enough to achieve only stabilization of blood pressure and CVP, and an increase in diuresis. Preoperative preparation begins immediately after the diagnosis is established and ends in the operating room, successively moving into the anesthetic management of the operation.

Operation steps for peritonitis

Operational access;
Elimination of the source of peritonitis;
Evacuation of exudate and toilet of the abdominal cavity;
Blind suturing of the wound or the introduction of drains or tampons into the abdominal cavity.

The best access for widespread peritonitis is a median laparotomy, which provides the possibility of a full revision and sanitation of all parts of the abdominal cavity. If widespread purulent or fecal peritonitis is detected only during an operation performed from a different incision, then you should switch to a median laparotomy. Removal of pathological contents and revision of the abdominal organs

After opening the abdominal cavity, the pathological contents are removed as completely as possible - pus, blood, bile, feces, etc. Particular attention is paid to the places of accumulation of exudate - subdiaphragmatic spaces, lateral channels, the cavity of the small pelvis.

The next stage is a revision of the abdominal organs in order to identify the source (or sources) of peritonitis. Under the condition of stable hemodynamics of the patient, this may be preceded by the introduction of 150-200 ml of a 0.25% solution of procaine (novocaine) into the root of the mesentery of the small intestine and under the parietal peritoneum. Since, under conditions of peritonitis, hydraulic trauma to the mesentery and infection of its tissue are undesirable, the same effect can be achieved by simply introducing 300-400 ml of a 0.5% solution of novocaine into the abdominal cavity. Based on the results of the revision, the severity of peritonitis, the possibility of simultaneous elimination of its source and the state of the patient's strength to transfer the required amount of surgery are assessed.

Good day, dear readers!

In today's article, we will consider with you a disease such as peritonitis, as well as its symptoms, stages of development, causes, types, diagnosis, treatment, folk remedies, prevention and other useful information. So…

Peritonitis - what is this disease?

Peritonitis- an inflammatory disease of the peritoneum, accompanied by acute pain in the abdomen, tension in the muscles of the abdominal wall, fever, nausea, flatulence, constipation and general severe malaise of the patient.

Peritoneum (lat. peritoneum)- serous membrane, consisting of parietal and visceral sheets, between which there is a cavity filled with serous fluid. The visceral layer covers the internal organs in the abdominal cavity, and the parietal layer lines its inner wall. The peritoneum protects the internal organs from infection, damage and other adverse factors affecting the body.

The main causes of peritonitis are internal, their perforations, as well as infection, mainly. For example, the cause of irritation, and after inflammation of the peritoneal wall, can be hydrochloric acid, released from the stomach with its ulcer with perforation. The same consequences can be in the presence of appendicitis, pancreatitis, diverticula, etc.

Peritonitis is a serious, life-threatening disease that requires urgent hospitalization and adequate treatment. If you slow down with the provision of medical care, the prognosis for the patient is very unfavorable.

Development of peritonitis

The course of peritonitis can be conditionally divided into three stages.

Peritonitis stage 1 (reactive, duration - up to 12 hours)- the initial reaction of the body to infection in the abdominal cavity, accompanied by a local inflammatory reaction of tissues in the form of edema, accumulation of exudate. The exudate is serous at the beginning, and as bacteria and protective cells (leukocytes) accumulate in it, it becomes purulent. The peritoneum has an interesting feature - by the method of gluing and adhesions of sheets to separate (delimit) the pathogenic microflora from other parts of the body. Therefore, due to fibrin deposits, at this stage, the appearance of adhesions in the peritoneum and adjacent organs is characteristic. In addition, at the site of the inflammatory reaction, in adjacent organs, swelling and infiltration processes can be observed.

Peritonitis stage 2 (toxic, duration - up to 3-5 days)- accompanied by the entry into the bloodstream and lymphatic system of bacteria, waste products of the infection (endotoxins) and protein products (proteases, lysosomal enzymes, polypeptides, etc.), as well as a more active immunological (protective) response of the body to the inflammatory process. There is an inhibition of the contractile activity of the intestine, degenerative changes in the surrounding organs, a hemodynamic disorder (c), typical signs of septic (endotoxin) shock - blood clotting disorders and others. In addition, symptoms such as nausea, diarrhea with constipation, general malaise, flatulence, fever, and abdominal pain are characteristic. The toxic phase of the disease can lead to the development of myocarditis, pericarditis and endocarditis, characterized by disruption of the entire cardiovascular system.

Peritonitis stage 3 (terminal, duration - from 6 to 21 days)- characterized by a high temperature, which after a while drops to low levels, rapid heart rate, decrease, blanching of the skin, nausea, vomiting, rapid weight loss, acute abdominal pain, diarrhea. The function of the liver for the formation of protein decreases, due to which its level falls, and the amount of ammonium and glycol in the blood increases. The brain does not remain unaffected, the cells of which swell, and the amount of cerebrospinal fluid increases.

Pathogenesis in peritonitis

On the part of the circulatory system, hypovolemia develops, which is accompanied by an increase in heart rate, an increase in blood pressure, which soon drops to low values, a decrease in the rate of portal blood flow, a decrease in venous return to the heart, and tachycardia.

From the gastrointestinal tract - as a reaction to the inflammatory process, intestinal atony appears. Due to circulatory disorders in the intestinal wall and irritation of its neuromuscular system with toxins, persistent paresis of the gastrointestinal tract develops, which in turn leads to hypovolemia, acid-base balance disorder, deposition of a large volume of fluid in the intestinal lumen, water disturbances, electrolyte, protein and carbohydrate metabolism. There are also signs of disseminated intravascular coagulation.

On the part of the respiratory organs - violations appear mainly in the later stages of the development of peritonitis and are characterized by hypoxia, impaired microcirculation in the lungs and their edema, lung perfusion appears, which, in combination with hypovolemia, leads to disruption of the myocardium and lungs.

On the part of the kidneys - as a result of the general reaction of the body to stress, spasms and processes of ischemia of the cortical layer appear at the first (reactive) stage of peritonitis, which, in combination with hypovolemia, leads to a deterioration in the functioning of the kidneys, the end result of which can be acute renal failure (ARF). ) or renal and hepatic insufficiency.

On the part of the liver - violations are observed at the initial stages of the development of the disease, and are characterized by hypovolemia and hypoxia of the liver tissues, which in the end can lead to parenchymal dystrophy.

Peritonitis Statistics

The end result of the development of peritonitis in 20-30% of cases is death, and in case of complications, mortality increases to 60%.

Peritonitis - ICD

ICD-10: K65;
ICD-9: 567.

The severity and symptoms of peritonitis largely depend on the severity of the underlying cause of the disease, infection, localization of the inflammatory process and the patient's health. However, consider the typical symptoms of the disease.

The first signs of peritonitis

Periodic sharp pains in the abdomen;
Increased body temperature;
General malaise,;

The main symptoms of peritonitis

Acute, especially aggravated by pressure on the anterior abdominal wall;
Muscle tension in the anterior abdominal wall;
Nausea, ;
, which decreases sharply after a while;
Rapid pulse,;
, acrocyanosis;
increased sweating;
Symptom of Shchetkin-Blumberg;
Symptom Mendel;
Symptom Francicus;
Resurrection symptom.

Complications of peritonitis

Acute renal failure (ARF);
Syndrome of intra-abdominal hypertension (SIAH);
septic shock;
Fatal outcome.

Among the main causes of peritonitis are:

Inflammatory diseases of various organs located in the abdominal cavity - appendicitis, salpingitis.

Perforations in the organs of the gastrointestinal tract (stomach, intestines, gallbladder, etc.), which can act as complications or, appendicitis, destructive cholecystitis, ulcerative,. This leads to the fact that the contents of the stomach, gallbladder, bladder (hydrochloric acid, bile, urine, blood) enter the free abdominal cavity, which causes irritation, and then inflammation.

Video about peritonitis

Peritonitis is an inflammation of the peritoneum, the thin membrane that lines the abdominal wall and protects the internal organs. Inflammation is usually caused by a bacterial or fungal infection of this membrane. There are two main types of peritonitis. Primary acute peritonitis is caused by the spread of infection into the blood and lymph nodes of the abdominal cavity. This type of peritonitis is rare - less than 1% of all cases diagnosed. The secondary type of peritonitis is more common. It occurs when the infection enters the peritoneum from the gastrointestinal tract and bile ducts. In both cases, the consequences of peritonitis are very serious and can be life-threatening if emergency medical measures are not taken.

Main symptoms

The clinical picture of peritonitis develops rapidly and is manifested by acute symptoms that can lead to pain shock. Possible signs of peritonitis include:

dull or acute pain of a diffuse nature over all surfaces of the anterior abdominal wall;
a sharp increase in body temperature to critical numbers;
complete lack of appetite;
severe thirst and dry mouth;
a feeling of heaviness in the abdomen is accompanied by the urge to vomit;
a sharp decrease in the volume of urine excreted;
violation of acts of defecation and natural discharge of gases from the intestines.

For any pain in the abdominal cavity, an immediate medical consultation is necessary. Acute peritonitis can develop in a few hours and lead to sudden death of the patient. Therefore, you should seek medical help in a timely manner.

Reasons for the development of inflammation

The primary form of acute purulent peritonitis is often caused by diseases of the liver, stomach and female genital organs. Any stagnation of fluid in the abdominal cavity is a favorable environment for the reproduction of pathogens. not infrequently, acute purulent peritonitis occurs due to ectopic pregnancy, ascites, appendicitis.

The following causes of peritonitis are no less common:

pancreatitis with pancreatic necrosis;
cholelithiasis;
perforation of a stomach ulcer;
acute poisoning with toxic substances;
burn disease;
spontaneous abortions and miscarriages;
criminal abortions at early and late stages.

In some cases, peritonitis develops after peritoneal dialysis. This may be a consequence of a violation of the rules of asepsis during medical procedures.

Clinical diagnosis of acute purulent peritonitis

For the timely diagnosis of peritonitis, a clear clinical picture is important. The use of various painkillers can distort it. Therefore, with acute pain in the abdomen and abdominal cavity, analgesics should not be taken on their own. Wait for the ambulance to arrive. An experienced specialist will examine you and prescribe the appropriate treatment.

By visual inspection, you can determine:

pain on palpation;
tension of the anterior abdominal wall;
swelling in the abdomen;
discoloration of the skin of the anterior abdominal wall up to a bluish tint;
blood pressure is lowered;
the pulse is quickened;
skin covered with sticky sweat;
peristalsis of the intestine during auscultation is not audible;
a sick person experiences severe pain in the peritoneum;
body temperature increased to 39 - 40 degrees Celsius.

In a hospital setting, the following procedures are performed:

complete blood count with a detailed leukocyte formula;
blood chemistry;
blood culture for bacteriocarrier;
analysis of fluid obtained by puncture of the abdominal cavity;
computed tomography of the abdominal organs;
X-ray examination of the abdominal cavity and pelvic organs in women allows you to quickly detect the cause of peritonitis.

Ultrasound is usually ineffective because of poor acoustics through the inflamed peritoneum.

Treatment

At the first symptoms of peritonitis, you should seek medical help. The death of a sick person can occur within a few hours after the first signs of this disease appear. Mandatory hospitalization in the surgical department is indicated. Emergency surgery is carried out in order to eliminate the cause of peritonitis and disinfect the peritoneum.

In the future, antibiotic therapy is used to control the growth and abundance of bacterial microflora. During the recovery period, drugs are used that promote tissue regeneration and restore the normal functioning of all abdominal organs.

When choosing an antibiotic, the doctor is based on the data of a preliminary analysis of the bacterial microflora of the contents of the inflammatory substrate in the peritoneal cavity. Sensitivity to antibiotics is determined. The course of treatment is at least 14 days.

Diet after peritonitis

In the first hours after surgery for peritonitis, complete food and drink rest is prescribed. It is only allowed to wet the lips of the patient. Restoration of the volume of blood and intercellular fluid is carried out parenterally with the help of intravenous infusions of glucose, blood plasma and saline.

In the future, the diet for peritonitis should include mashed foods, mucous porridge, jelly. Products that cause active intestinal peristalsis are excluded. The determination of the final diet largely depends on the cause of peritonitis, that is, on the underlying disease. When removing the gallbladder, this will be one diet, with a resection of the stomach, you will be given completely different recommendations. The amount of food in one serving should be sharply reduced. Meals should be frequent and fractional.

Prevention and treatment of dysbacteriosis is important. After surgery on the peritoneum against the background of antibiotic therapy, the intestinal microflora suffers to a large extent. Therefore, the doctor may recommend the use of special supplements, which include lactobacilli, bifidobacteria and various strains of E. coli.

Possible complications

Complications of peritonitis can be divided into immediate consequences and long-term health problems. complications of the immediate type include sepsis, blood clotting, death of the patient, acute renal failure, bleeding, collapse, shock conditions. In the future, peritonitis can remind itself of adhesive disease, postoperative hernias, and intestinal motility disorders. A number of patients who have had acute purulent peritonitis develop intestinal obstruction and oncological diseases of the abdominal organs. In women, peritonitis may complicate the obstetric history. More than 20% of women who have had acute peritonitis in the future experience difficulties with the onset of physiological pregnancy.