Peritonitis: symptoms, causes, diagnosis and treatment

Peritonitis is an inflammation of the peritoneum. This disease is considered in the framework of the concept of acute abdomen, which is characterized by pain with muscle tension in the region of the anterior abdominal walls. Despite the fact that every year the treatment technique is improved more and more, this pathology does not become less dangerous. The mortality rates due to peritonitis are still extremely high. For example, with the local form of peritonitis, mortality is six percent, and with spilled - more than forty-five. We will tell about what symptoms are observed with peritonitis, what are its causes and what needs to be done to cure the patient.

Peritonitis and its causes

The peritoneum is the serous membrane covering the organs of the abdominal cavity. The peritoneum lining the inner walls of the abdomen is called parietal, and the surface of the organs is called visceral. Its total area is approximately 2m ² .

The peritoneum has an absorption capacity, which is designated as a resorptive function. At the same time, it can release fluid along with fibrin into the abdominal cavity. This ability is called exudative function. Normally, such processes are balanced, and only a certain amount of fluid is contained in the abdominal region. During pathological conditions, the exudation process is activated, due to which excess fluid can accumulate in a significant amount in the abdominal region.

So what are the causes of peritonitis?

It can be primary when the disease develops due to the ingress of microorganisms into the abdominal region with a flow of lymph or blood, and secondary when the pathology is formed as a result of inflammation, perforation and damage to organs that are in the abdominal cavity. The following causes are identified that lead to the occurrence of peritonitis:

1. The appearance of inflammatory processes in the abdominal organs, for example, conditions such as appendicitis along with cholecystitis and salpingitis.
2. The process of perforation in the organs of the abdominal region. For example, this can happen in the stomach or intestines in the presence of peptic ulcer. In addition, peritonitis after appendicitis occurs very often or after destructive cholecystitis, as well as with the development of ulcerative colitis.
3. The presence of damage to the organs of the abdominal region.
4. Operations that were performed on the organs of the abdominal region. Peritonitis after cesarean section is a common occurrence.
5. The development of hematogenous peritonitis, for example, as a result of pneumococcal and streptococcal infections.
6. The appearance of inflammatory processes of any origin that are not associated with the abdominal cavity (for example, purulent processes that are localized in the retroperitoneal tissue).

Forms of ailment

The causes of peritonitis are of interest to many. The bacterial and aseptic forms of the disease are distinguished. The causative agent of the bacterial form of this pathology can serve as various aerobic microorganisms in the form of Escherichia coli or Pseudomonas aeruginosa, as well as Klebsiella, Proteus and Staphylococcus aureus. Anaerobic parasites in the form of bacteroids, clostridia and peptococci also provoke the bacterial form. It often happens that peritonitis provokes microbial associations, that is, a combination of several microorganisms at once.

Aseptic peritonitis can develop during contact of the peritoneum with blood, gastric or intestinal contents, and, in addition, with bile or pancreatic juice. It is interesting to note that after a few hours, microflora can be involved in the process, as a result of which aseptic peritonitis acquires a bacterial nature.

Varieties of peritonitis

Depending on the prevalence of the pathological process, the following forms of peritonitis are distinguished:

1. With local peritonitis, only one anatomical section of the abdominal region is involved.
2. Against the background of the common type, two to five anatomical parts of the cavity are involved.
3. In the total type involved from six anatomical departments of the abdominal region. So you need to understand that peritonitis after surgery is not excluded.

It is equally important to consider the type of exudate. Thus, depending on the exudate, the following forms of peritonitis are distinguished:

1. The development of serous form.
2. Fibrinous form of peritonitis.
3. Purulent form of pathology.
4. Hemorrhagic form.
5. Biliary form of peritonitis.
6. Fecal form.
7. A mixed form of the disease.

The development of peritonitis is different. It can be acute or chronic. The chronic type of the disease is more common with systemic infections of the body, for example, with syphilis or tuberculosis. Acute peritonitis can occur in three phases, ranging from reactive to toxic and terminal.

The first signs of peritonitis are recorded in patients in the first twenty-four hours of the disease. At this time, peritoneal edema occurs, and, in addition, exudation with the loss of fibrin. Moreover, the local symptoms of the disease will be especially expressed in the clinical picture. The second toxic stage develops after forty-eight hours. During this period, an increase in toxicosis occurs, as a result of which general intoxication symptoms prevail over the local one. The third terminal stage develops after seventy-two hours. At this time, severe intoxication is observed. Next, find out what are the symptoms of peritonitis.

Symptoms of ailment

All the symptoms observed with peritonitis are divided into local and general. Local symptoms appear in response to the occurrence of peritoneal irritation with exudate. In addition, the peritoneum may be irritated by bile or gastric contents. Symptoms of peritonitis include the appearance of abdominal pain along with muscle tension in the abdominal walls.

Positive symptoms of peritoneal irritation, which the doctor can identify during the examination, are also noted. General symptoms, as a rule, develop with intoxication of the body. These are nonspecific signs in the form of fever, weakness, tachycardia, nausea, vomiting and confusion. In addition, patients have not only symptoms of peritoneal inflammation, but also signs of the underlying disease that provoked the pathology.

Symptoms of the first stage of pathology

The first symptom of peritonitis is a constant, and at the same time, non-abating pain in the abdomen, which continues to increase with a change in position. In this regard, the patient usually lies on his back or side with his knees pressed to his stomach, trying not to move again. The localization of uncomfortable sensations directly depends on the location of the pathological process in the peritoneum.

During the examination of the patient, the doctor manages to determine the muscle tension of the abdominal wall. At the first stage of peritonitis, positive symptoms of peritoneal irritation are noted. To determine the Blumberg symptom, you should slowly press on the stomach, fixing your hand on it for a couple of seconds, and then sharply pull it back. In the event that at this moment a strong, and at the same time sharp pain occurs, this will mean that the person has peritonitis.

Mendel's symptom is determined by tapping the entire area of ​​the abdomen. By the reaction of the patient, doctors can determine not only the intensification of pain, but also the location of the pathological process. Of the general symptoms in patients, an increase in temperature is noted along with tachycardia, increased pressure, dry mucous membranes, and nausea and vomiting are also observed.

How do symptoms occur in the second stage of peritonitis?

The second stage of the disease and its main symptoms

At this time, abdominal pain becomes less pronounced. But at the same time, the muscle tension of the abdominal walls, as well as the symptoms of their irritation, is present, becoming less pronounced. As a rule, such signs as a retention of stool with flatulence and bloating, which is caused by intestinal paresis, come to the fore. Abundant vomiting with the presence of a fetid odor may be noted.

Then there is an increase in general intoxication symptoms. Patients have a rapid heartbeat, which is more than one hundred and twenty beats per minute, and the pressure also drops significantly. The temperature rises, and the tongue from the oral mucosa becomes dry, the facial features are sharpened.

The third stage of pathology and its symptoms

Intoxication at this stage becomes even brighter. As a result of dehydration, the patient’s skin begins to turn pale, and the face is sharpened, the mucous membrane of the mouth with the tongue is usually dry. Heart palpitations with low pressure may persist, and breathing is frequent and shallow.

In the third stage, the patient’s abdomen is greatly swollen, and peristalsis is completely absent, there is abundant vomiting, against which the gastric and intestinal contents come out. Due to the severity of intoxication, the nervous system begins to suffer, as a result of which the patient can be dynamic or fall into euphoria. In addition, delirium and confusion are noted. Now we will consider what research is being conducted as part of the diagnosis of this pathology.

Diagnosis of peritonitis

How to identify such a dangerous ailment? If you have symptoms of an acute abdomen, the following medical tests are performed:

1. Conducting a clinical blood test. As a rule, as a result of sampling this analysis, patients have leukocytosis along with a left shift of the leukocyte formula.
2. Perform rectal and (for women) vaginal examinations. This diagnostic method allows you to determine the pronounced pain of the intestinal walls, which is due to irritation of the peritoneum.
3. Performing an X-ray examination of the organs of the abdominal region. This method allows you to determine the dimming of the peritoneum, which is due to the exudate accumulated there.
4. Ultrasound examination of the abdominal cavity, allowing to detect the presence of excess fluid.
5. Performing laparocentesis - puncture of the abdominal cavity. Such a study makes it possible to study the contents of the abdominal region.
6. Laparoscopy is performed if there is a doubt in the diagnosis.

Next, find out how the patient is treated with peritonitis.

Conducting treatment for this pathology

Treatment of peritonitis is carried out promptly. The purpose of surgery is to eliminate the cause that led to the development of the disease. In addition, abdominal drainage is performed.

What do peritonitis do in surgery? The sequence of actions is as follows:

1. Conducting preoperative preparation, in the framework of which the digestive system is cleaned and anesthesia is performed.
2. Carrying out a laparotomy. With this procedure, the anterior abdominal wall of the abdomen is cut.
3. Elimination of the source of peritonitis. For example, the appendix can be removed, and ulcer resection is performed, the walls of the organ are sutured.
4. Performing sanitation of the abdominal cavity. As part of this procedure, rinsing occurs using antiseptic solutions.
5. Intestinal decompression.
6. Enter drainage into the abdominal region.
7. Conducting suturing wounds.

The prognosis for a subsequent recovery will be better the sooner the operation is performed. The optimal operation is considered to be in the first few hours of the disease. Surgical intervention, which was performed a couple of days after the onset of the first symptomatology, significantly reduces the chances of the patient recovering. Therefore, in case of abdominal pain, in no case should you hesitate, you need to urgently consult a doctor.

The treatment of peritonitis is usually supplemented with medications. The goal of drug therapy is the elimination of pathogenic microflora along with the correction of metabolic disorders. The following groups of medications are used:

1. Antibiotics. Antibiotics with a wide spectrum of effects are predominantly used, for example, Gentamicin is used along with Sigmamycin, Benzylpenicillin, Ampicillin and Ceftriaxone.
2. The use of detoxification agents. In this case, for example, a ten percent solution of calcium chloride is used.
3. The use of infusion solutions of glucose, hemodesis, and so on.
4. The use of colloidal agents and protein preparations of the blood.
5. The use of diuretics, for example, Furosemide and Mannitol.
6. The use of non-steroidal anti-inflammatory drugs, such as Ibuprofen and Paracetamol.
7. The use of antiemetic drugs, for example, Metoclopramide.
8. The use of anticholinesterase agents, for example, Proserinum. It is used to prevent the occurrence of intestinal paresis.

You should pay attention to the fact that if you experience abdominal pain, you can not independently prescribe yourself taking painkillers. This can lead to the fact that the symptoms of the disease will become less pronounced and doubtful, because of which it will be extremely difficult for the doctor to make the correct diagnosis on time.

The consequences of peritonitis are very serious, even fatal.

What should be postoperative care?

After surgery, it is important for the patient to continue drug treatment in order to prevent complications. Already on the second day after the operation, parenteral nutrition should begin. The volume of infusion treatment is approximately 50-60 milliliters per kilogram of body weight per day. A special diet is introduced after peritonitis. Immediately after the restoration of intestinal motility, they switch to the enteric type of nutrition. Against the background of such nutrition, the mixture is administered using a probe through the nose and mouth. The composition of the nutritional mixtures and the duration of such feeding is determined by the doctor. All this is very individual.

Against the background of the positive dynamics of the restoration of the normal functioning of the intestines of the patient, they are transferred to natural nutrition. This becomes possible, as a rule, not earlier than on the fifth day after the operation. At the same time, it is very important that the patient is on a low-calorie diet. During this period, you should eat lean meat broths, mashed vegetables, jelly and stewed fruit. Gradually, you need to increase the calorie content of the diet and add dairy products with meat and eggs to it. It is forbidden to use saturated meat broths, smoked meats, spices, confectionery, chocolate, coffee, carbonated drinks and legumes.

Several times a day, doctors should examine the postoperative wound, paying attention to the cleanliness of the dressing, and, in addition, to the degree of getting wet. The dressing should be changed regularly. During the change of dressing, observe the rules of antiseptics, avoiding the displacement of the drainage tube. If you follow all the recommendations of your doctor, the treatment of the disease will be successful.