Peritonitis

PeritonitisPERITONITIS - inflammation of the peritoneum, accompanied by General symptoms of the disease organism with dysfunction of vital organs and systems. Depending on the nature of effusion distinguish serous, fibrinous, purulent, hemorrhagic, septic and fecal peritonitis. Of microbial pathogens often sown Association: stafilo, Streptococcus, E. coli, pneumatic and gonococci and a large group of anaerobic bacteria, which has recently been given more and more importance. The main causes of peritonitis acute destructive appendicitis, perforated ulcer of stomach and duodenal ulcers, acute destructive cholecystitis, diverticulitis, colon cancer or diverticulitis ileum (mckelva diverticulum), perforation of the tumor of the colon or rupture of the cecum with malignant bowel obstruction, traumatic rupture of hollow organs with closed abdominal trauma. Less peritonitis develops after surgery. At entry into the peritoneal cavity of gastric contents, pancreatic enzymes, bile, blood, urine, develops toxic chemical peritonitis. The pathophysiology. Infection and the effects of toxins on the peritoneum lead to congestion, edema, extravasation of fluid in the abdominal cavity, fibrinous overlays on the parietal and visceral peritoneum, demarcates the inflammatory process. In the absence of such limitations the toxins and germs spread throughout the abdominal cavity, there is a diffuse peritonitis. In the presence of growths and adhesions inflammatory process is limited to a particular region of the abdominal cavity, however, the absorption of toxins is through the lymphatic system, and irritation of nerve endings leads to reflex inhibition of intestinal peristalsis, which is the progression of peritonitis may go into the full dynamic kicheche obstruction. The secretion of fluid into the lumen of the intestine with the proceeds, but it is virtually absent resorption, which leads to sequestration of fluid in the lumen and the intestinal wall. For peritonitis characterized by significant (4-6 liters or more per day) fluid sequestration due to stack peritoneal fluid accumulation in the wall and lumen of the intestine and abdominal cavity. Peritonitis leads to stimulation of many endocrine organs: within 2-3 days after the onset of peritonitis, the stimulation of the cortical layer of the adrenal cortex. Epinephrine lead to vasoconstriction, tachycardia and reinforcements permeability. The secretion of aldosterone and antidiuretic hormone causes growth of hypovolemia, sodium and water. The decrease in volume of circulating blood and infection (effects of exotoxins and endotoxins) are the causes of mixed (hypovolemic and septic) shock. The symptoms for. The diagnosis of peritonitis put mainly on the basis of the clinical picture of the disease. Survey and intensive conservative treatment should not delay the timely and adequate surgical intervention. Initial symptoms are consistent with a basic disease, which leads to the development of peritonitis (acute appendicitis, acute cholecystitis, diverticulitis etc). Against this background, the marked increase in pain, the pain increases sharply and quickly spreads throughout the abdomen. The language in the initial stages of coated, wet. Abdomen tense in all departments, sharply painful, the symptoms of peritoneal irritation positive, percussion tenderness is maximal in the area of primary focus of infection. You should determine hepatic dullness, flatness or lack EE - a sign of perforation of a hollow organ. Clinical manifestations depend on the stage of peritonitis. Isolated reflex, toxic and terminal stage. In the terminal stage of diagnosis is not much difficulty: the Hippocratic face, dry (like a brush), coated tongue. Belly swollen, tense and painful in all departments, are positive signs of peritoneal irritation, peristalsis is absent. Characterized by tachycardia, unstable blood pressure, oliguria. In the blood - high leukocytosis, left shift Formula. In biochemical studies - increased bilirubin, creatinine, urea (renal and hepatic failure). Radiographic features: free gas under the dome of the diaphragm (perforation of a hollow organ), gas anatomically containing gas structures (millevoi or subphrenic abscess). The presence of fluid levels in the small and large intestine showed paralytic ileus. The radiological examination of the chest cavity define atelectasia pneumonic lesions, effusion in the pleural cavity. In diagnostically difficult cases, using laparoscopy. To diagnose delimited peritonitis, abscess using ultrasound. Postoperative peritonitis has some peculiarities, due to widespread use of postoperative analgesics and antibiotics. However, the diagnosis of postoperative peritonitis with constant monitoring of patients in most cases it is possible to diagnose in time. An exception may be only patients on mechanical ventilation. In the diagnosis are important changes in pain, increase in tachycardia, unstable blood pressure, He settled paresis of the intestine, changes of blood (rising leukocytosis and left shift formula, increased creatinine, urea, bilirubin). When x-ray examination with a water-soluble contrast can reveal nesostoyatlnost seams anastomosis is the most common cause of postoperative peritonitis. Operative treatment of peritonitis. The loss of time with early surgical intervention threatens the development of severe complications (septic and hypovolemic shock) and death. When severe the patient's condition required a short (2-3 hours) preparation for the correction of volemic violations and bring the patient in operable condition. The operation was performed under endotracheal anesthesia. As access in diffuse peritonitis apply broad median laparotomy. Principles of surgical treatment: 1). reorganization of the primary site of infection (for example, aptsendektomiya, holetsistzktomiya, closure of perforated ulcer and others) and the abdominal cavity, which was washed with isotonic sodium chloride solution or 0.25% novocaine with the addition of antibiotics and antiseptics. Application furatsipina undesirable; 2).


  > > > >  

Похожие статьи

Ваше имя
Ваша почта
Город, область
Рассылка комментариев





Ввести код: