Diseases of the internal organs require careful attention and timely therapy. Not only the quality of life, but also its duration directly depends on this. Among such pathologies there are life-threatening, for example, peritonitis of the abdominal cavity. In the absence of timely medical care, a high probability of death. In this article, we will consider the symptoms, causes and treatment tactics.
What is peritonitis
This pathology is an inflammation of the abdominal cavity. Often, the disease is referred to among doctors as an "acute abdomen." The inflammation of the serous membrane provokes the process.
According to statistics, the frequency of diagnosis of pathology is from 0.05 to 0.3%. Previously, almost 70% of all cases were fatal, but now, taking into account the level of development of medicine, the percentage has dropped to 15-19%, but these figures are considered high.
Causes of peritonitis
Pathology can develop in any age group, regardless of gender. This happens due to the penetration of pathogenic agents into the sterile cavity, which leads to peritonitis of the peritoneum.
If there is a violation of the integrity of the walls of internal organs, then physiological fluids are poured out, violating the sterility of the cavity. The accelerated development of pathogenic microflora leads to the development of the disease.
Most often provoke peritonitis of the abdominal cavity:
- Rupture of the appendix (appendix).
- The formation of a perforated gastric or duodenal ulcer.
- Perforation of the walls of internal organs.
- Rupture of neoplasms of internal organs.
- Surgical interventions on the abdominal organs.
- The consequences of labor.
- Necrotic processes in the intestine against the background of the formation of a hernia.
- The inflammatory process with the development of bowel obstruction.
- Perforation of the gallbladder.
- Injury to the gastrointestinal tract by foreign bodies or chemicals.
- Hemorrhage in the abdominal cavity when a fallopian tube ruptures against an ectopic pregnancy.
Peritonitis of the abdominal cavity can provoke diseases of the reproductive sphere, fluid accumulation with the development of liver failure.
Pathology classification
The disease can occur in two forms:
- Primary peritonitis. The disease is caused by microorganisms that enter the peritoneum from a pathological site with blood flow. The integrity of the abdominal cavity is preserved. But all the symptoms of the pathology will be there.
- The secondary form is characterized by rupture or damage to the abdominal layer as a result of a penetrating injury, for example, a knife wound or a gunshot wound.
- Tertiary. This type of pathology is the most severe and is formed against the background of severe exhaustion after surgical interventions, diseases and injuries.
There is another approach to classification by clinical manifestations:
- Acute peritonitis. It develops within a few hours after the penetration of physiological fluid into the abdominal cavity. Symptoms are developing rapidly.
- Chronic. It is diagnosed against the background of infection of the body. This is often observed with tuberculosis, syphilis, because the infection is constantly present.
Peritonitis of the abdominal cavity and microbiological features are different. With this in mind, there are:
- Viral or bacterial, which is caused by pathogenic microorganisms.
- Enzymatic
- Carcinomatous, parasitic, rheumatoid. They differ among themselves in the nature of the course and the cause.
The treatment tactics and the choice of drugs are influenced by the nature of the accumulated fluid, therefore, they distinguish:
- Serous peritonitis.
- Fibrinous.
- Purulent.
- Hemorrhagic.
- Gangrenous.
It should also be borne in mind that inflammation of the abdominal cavity can capture only a limited area or extend to the entire cavity. The larger the space covered by the inflammatory process, the more serious the treatment is required, and it will be difficult and lengthy.
Stages of the development of pathology
Most often, inflammation develops rapidly, and only a quick response from doctors and assistance can save a person's life. The acute form of the disease proceeds with a change in several stages:
- Reactive. It is observed during the first day. Symptoms of malaise appear as a result of the onset of fluid accumulation in the abdominal cavity.
- Toxic It appears after 24-72 hours. Intoxication progresses, which leads to a sharp deterioration in the patient's condition.
- The terminal phase occurs after three days. There is a toxic shock, a high probability of death.
If you do not take measures to assist the person in the first two stages, then do not avoid the dire consequences. Depending on the general condition of the body, death can occur at the first stage, so self-medication is unacceptable. Much depends on the strength of the immune system, general health.
Symptoms of the disease
All signs of peritonitis of the abdominal cavity can be divided into local and general. The first group develops against the background of peritoneal irritation with the contents of the stomach or intestines. The following symptoms appear:
- Abdominal pain of varying intensity.
- The abdominal wall is tense.
- The temperature rises.
- There is a weakness.
- Heart rhythm is disturbed.
- Nausea is accompanied by vomiting.
- Confused consciousness.
Along with these signs, symptoms of the disease that provoked peritonitis are noted.
The severity of symptoms also depends on the stage of development of the pathology:
- During the terminal stage, the patient, due to abdominal pain, occupies a forced position with legs brought to the stomach. Due to the penetration of microorganisms into the blood:
- an increase in temperature, indicators on a thermometer depend on the pathogenicity of bacteria, for example, staphylococci provoke an increase to 39-40 degrees;
- the patient is constantly sick and vomits;
- heart palpitations;
- shallow breathing;
- with severe pain syndrome - confusion.
2. The toxic stage is characterized by the following manifestations:
- hepatic insufficiency develops due to the penetration of microorganisms into the liver along with blood flow;
- breathing is frequent and intermittent;
- vomiting is accompanied by the release of fetid masses;
- water-electrolyte metabolism is disturbed;
- tormented by constant thirst;
- the tongue is dry and brownish;
- blood pressure drops;
- due to the loss of water and salts, arrhythmia develops;
- cramps appear;
- bloating.
3. The terminal stage is characterized by severe dehydration and the development of a precomatose state:
- eyes and cheeks sink;
- integuments become earthy;
- the stomach is greatly swollen, and any touch of it causes severe pain;
- the pulse is threadlike and barely audible;
- confused consciousness.
Symptoms of the last stage are now rare, thanks to timely medical care.
Diagnosis of peritonitis
If you suspect an “acute abdomen”, the following studies will help confirm or refute them:
- A blood test shows a high white blood cell count.
- Radiography of the abdominal cavity reveals a blackout, which indicates the accumulation of exudate.
- Ultrasound detects fluid.
- Puncture of the abdominal cavity is performed to study its contents, to determine the pathogenicity of microorganisms in order to more efficiently select drugs.
- A rectal or vaginal examination reveals soreness that is provoked by inflammation of the peritoneum.
After confirming the diagnosis, depending on the stage of the disease, treatment is prescribed.
Medical assistance
The main treatment for peritonitis in the abdominal cavity is surgery. She pursues the following goals:
- Removal of accumulated fluid and infected tissues.
- Resection or isolation of the site that provoked the inflammatory process.
- The release of the gastrointestinal tract from gases and fluids.
- Sanitation of the abdominal cavity.
If peritonitis of the abdominal cavity is diagnosed, the operation involves the following steps:
- Preparing the patient for surgery. It involves the correction of impaired body functions, cleansing the gastrointestinal tract and anesthesia.
- A section along the midline of the abdomen. This arrangement allows access to all organs with extensive peritonitis of the abdominal cavity.
- Elimination of the cause of the inflammatory process. If the source is the appendix or gall bladder, then it is removed. If another internal organ ruptures, the removal of which is unacceptable, it is sutured.
- Sanitation of the abdominal cavity. Washing is carried out using sterile solutions. This can significantly reduce the number of pathogenic microorganisms and quickly eliminate the infection. The solutions are pre-cooled to a temperature of +4 to -6 degrees to narrow the vessels and reduce the intensity of metabolic processes.
- At the next stage, intestinal decompression is performed to remove fluid and gases. The procedure is carried out by introducing a thin probe through the oral cavity into the intestine, it is introduced through the anus to drain the colon.
- Abdominal cleansing. The drainage process is carried out using hollow tubes that are inserted from both sides of the diaphragm, under the liver. If peritonitis is detected during surgery, special preparations are administered through the catheter, and after a while they are removed.
- The last stage of abdominal surgery involves suturing the wound. Various methods may be used to do this, taking into account the proposed postoperative therapy.
The faster the operation will be performed upon detection of peritonitis, the greater the chance of a full recovery. Death from peritonitis of the abdominal cavity often occurs if pathology is detected at the terminal stage.
After surgery, therapy involves taking medications that are designed to destroy pathogenic microorganisms and restore impaired metabolic processes.
The doctor prescribes:
- Antibacterial drugs: "Gentamicin", "Ceftriaxone". Broad-spectrum agents are selected.
- Detoxification agents: "Calcium Chloride" 10%.
- Infusion therapy with the introduction of "Glucose" 5 or 25% solution, Ringer's solution.
- Blood products: plasma, albumin.
- Nonsteroidal anti-inflammatory drugs: Ibuprofen, Paracetamol.
- In order to prevent intestinal paresis, anticholinesterase agents are prescribed: Proserinum.
Treatment of peritonitis of the abdominal cavity is a long and complex process, especially if the operation was not performed immediately. The postoperative period is equally important.
Postoperative Recovery
To reduce the likelihood of complications after peritonitis of the abdominal cavity, postoperative therapy is important. Its features are as follows:
- The day after surgery, you can start parenteral nutrition. The volume of infusion fluid is not more than 50 ml per kilogram of weight.
- After restoration of intestinal motility, nutrient mixtures are administered through the mouth.
- After the normalization of the gastrointestinal tract, the patient begins to eat on their own.
- Every day, several times a day, the doctor examines the postoperative suture.
- Every day you need to change the bandage.
- Compliance with all antiseptic requirements will prevent the development of complications after surgery.
Post-operative diet
The diet after peritonitis of the abdominal cavity depends on the recovery period, and there are three of them:
- Early. It lasts from 3 to 5 days after surgery.
- The second period lasts up to three weeks.
- The third ends after full recovery.
It is possible to provide the patient’s body in the first days after surgery with nutrients only by artificial means. Served by intravenous administration. A few days after the restoration of peristalsis, the nutrient mixture can be administered through a probe.
The composition of the nutrient mixture is determined by the doctor, taking into account the patient's condition. This type of feeding allows you to accelerate recovery and reduce the risk of complications after surgery.
After stool normalization, the patient switches to food in a natural way. The main rule: the introduction of new products should be carried out gradually. The doctor must constantly monitor the patient's condition.
In the first days of natural nutrition, the calorie intake should be low, not more than 1000 kcal per day. The amount of salt must be reduced to a minimum, but liquids - use at least 2 liters.
The menu can include:
- Jelly and jelly.
- Meat broth, but not greasy.
- Soft-boiled eggs.
- Homemade fruit and vegetable juices.
- Vegetable puree with a little butter.
If the patient feels normal with the transition to this type of nutrition, bowel movement occurs regularly, then you can diversify the diet. The main thing is that it ensures the supply of all necessary nutrients and contributes to the normalization of the gastrointestinal tract.
Gradually, you can add meat, but not fatty varieties, fish, dairy products, vegetable oils to the diet.
It is better to exclude after peritonitis:
- Sugar and jam.
- Butter baking.
- Honey.
Food must adhere to the following rules:
- To eat in small portions, but often.
- Last meal - no later than 2 hours before bedtime.
- The consistency of the food should be mushy or liquid.
- Products are best boiled or steamed.
- After eating, lie down for 15-20 minutes in a horizontal position.
- Drinking half an hour after a meal. At a time, the volume of fluid consumed should not exceed 200 ml.
- Do not eat foods that stimulate increased secretion of digestive juices. This includes spices. seasonings, marinades.
The diet should have enough vitamins and essential minerals.
If after taking certain foods there is discomfort or pain in the intestine appears, then you should refuse to take them.
Nutritional recommendations after discharge from the hospital
The third stage coincides with the discharge from the hospital, and gradually the food is enriched with new products, the consistency of dishes becomes more solid. It is recommended to adhere to the following rules:
- Introduce dishes of different heat treatment.
- Gradually increase the calorie intake.
- Replace semi-liquid foods with solid ones.
The restrictions include:
- Decreased sugar intake.
- Use of spices to a minimum.
- Continued adherence to the principle of fractional nutrition.
- Lack of indigestible food.
The consequences of peritonitis
What is dangerous peritonitis of the abdominal cavity is the development of serious complications. They can begin their development not only during pathology, but also after surgery. Most often diagnosed:
- Renal failure.
- Complications in the pulmonary system.
- Toxic shock.
- Dehydration.
It happens when the pathology develops again after surgery, then urgent sanitation of the abdominal cavity in postoperative peritonitis is required. It should be noted that the repeated form is much more difficult, both in symptomatology and in the required treatment. High risk of developing it in patients with high weight, in the presence of diabetes. You can also expect after surgery:
- Intestinal paresis. Complication is difficult to correct.
- The formation of adhesions. This process is almost inevitable, since during the operation the integrity of the peritoneum is violated.
- Suture infection.
- Patient exhaustion. The restoration of previous body weight sometimes takes several months.
The percentage of deaths with peritonitis is quite high. With the development of a purulent form, it reaches 15. If surgery was performed in the first few hours of the development of the disease, a favorable outcome is expected in 90% of cases.
The treatment of peritonitis is complex and requires a competent approach on the part of the doctor, and the patient must unconditionally comply with all recommendations. The more effective therapy is selected and the operation is qualified, the higher the chance of an early recovery and a decrease in the likelihood of complications.
Any pathology requires a serious attitude, this is the only way to maintain health and lead a normal lifestyle for many years. This is especially true for a disease such as peritonitis. In this case, procrastination is fatal.