Peritonitis

Introduction to peritonitis Peritonitis is inflammation of the peritoneal and visceral peritoneum of the abdominal wall. It can be caused by bacterial, chemical, physical damage, etc. According to the pathogenesis, it can be divided into primary peritonitis and secondary peritonitis. Acute suppurative peritonitis involving the entire abdominal cavity is called acute diffuse peritonitis. Its main clinical manifestations are abdominal pain, abdominal muscle tension, as well as nausea, vomiting, fever, severe blood pressure drop and systemic toxic reactions. If not treated promptly, it can die of toxic shock. Some patients may have pelvic abscess, intestinal abscess and underarm abscess, axillary abscess and adhesive intestinal obstruction. basic knowledge The proportion of illness: the incidence rate is about 0.003% - 0.006% Susceptible people: no special people Mode of infection: non-infectious Complications: underarm abscess dehydration

Cause of peritonitis

Primary peritonitis (30%):

Primary peritonitis is rarely seen clinically. It refers to the absence of primary lesions in the abdominal cavity. The pathogens are peritonitis caused by infection of the abdominal cavity via blood circulation, lymphatic pathway or female reproductive system. More common in physical weakness, severe liver disease patients or in the case of low disease resistance.

Secondary peritonitis (30%):

Secondary peritonitis is the most common acute peritonitis in the clinic, secondary to perforation of organs in the abdominal cavity, rupture of organs, inflammation and surgical contamination. It is a common surgical acute abdomen. Its pathological basis is that the peritoneal wall layer and/or visceral layer are stimulated or damaged by various reasons to cause acute inflammatory reaction, which is caused by bacterial infection, chemical stimulation or physical damage.

Peritonitis prevention

Most peritonitis can be prevented. Common causes of illness such as appendicitis, gastroduodenal ulcer, etc. should be detected early and treated promptly. Abdominal surgery should be strictly followed to prevent gastrointestinal fluid spillage to prevent contamination of the abdominal cavity. Prevent upper respiratory tract infections during childhood, enhance physical fitness and improve physical resistance. Early and appropriate treatment of intra-abdominal inflammatory diseases that may cause peritonitis is a fundamental measure to prevent peritonitis. Any abdominal surgery or even abdominal puncture should be strictly performed aseptic operation. Oral administration of antibacterial drugs before enteral surgery can reduce the incidence of peritonitis.

Peritonitis complications Complications, underarm abscess dehydration

If peritonitis is not treated quickly and effectively, multiple systemic failure will occur rapidly. Loss of fluid into the abdominal cavity and intestine can lead to severe dehydration and electrolyte imbalance, and the patient has a mask-like expression (Hippocratic bottom) and can be within a few days. Death, adult respiratory distress syndrome can also occur rapidly, followed by renal failure, liver failure and disseminated intravascular coagulation.

Abdominal abscess occurs in the pelvic cavity, the infraorbital space, the left or right colon space, the subhepatic space and the intestinal fistula. Must pass the clinical examination, ultrasound (useful for the examination of pelvic or sub-abdominal abscess), CT (check the underarm Abscesses are most effective, and sometimes laparotomy is used. Percutaneous catheter drainage under ultrasound or CT guidance is often possible.

Adhesion or banding is a late complication that often causes later obstruction.

Symptoms of peritoneal inflammation Common symptoms Diffuse mesangial sclerosing Diffuse umbilical pain Pain abdominal pain Nausea Abdominal discomfort Left abdomen flexion Right abdominal pain Diarrhea Force supine position

The main clinical manifestations of acute peritonitis, early symptoms of peritoneal irritation such as (abdominal pain, tenderness, abdominal muscle tension and rebound tenderness), and later due to infection and toxin absorption, mainly manifested as symptoms of systemic infection.

1, abdominal pain:

This is the most common symptom of peritonitis, and the degree of pain is generally severe and persistent.

2, nausea, vomiting:

This is a common symptom that occurs early.

3, fever:

Sudden onset of peritonitis, the body temperature can be normal at the beginning, and then gradually increase, the elderly debilitated patients, the body temperature does not necessarily increase with the severity of the disease.

4. Infection with toxic shock.

5, abdominal signs:

Abdominal breathing is weakened or disappeared, accompanied by obvious abdominal distension. Aggravation of abdominal distension is often an important indicator for judging the development of the disease.

Peritonitis check

1. tenderness and rebound tenderness are the main signs of peritonitis. They always exist. The degree of abdominal muscle tension varies with the cause and the general condition of the patient. Abdominal percussion can be drum sound due to flatulence, and intra-abdominal effusion. For a long time, you can take out the mobile voiced sound, or you can use it to locate the necessary abdominal puncture. Auscultation often finds that the bowel sounds are weakened or disappeared.

2, laboratory and X-ray examination:

The blood routine white blood cell count is increased, but when the condition is severe or the body's response is low, the white blood cell count may not be high. Abdominal X-ray examination shows that the intestinal lumen is generally flat and there are multiple signs of intestinal paralysis such as small gas level (should be in perspective).

Diagnostic diagnosis of peritonitis

diagnosis

Diagnosis can be performed based on clinical performance and laboratory tests.

Differential diagnosis

1. Internal medicine diseases: There are many medical diseases with clinical manifestations similar to peritonitis, which must be strictly differentiated to avoid false treatment, pneumonia, pleurisy, pericarditis, coronary heart disease, etc. can cause reflex abdominal pain, and pain can also be caused by respiratory activity. The weight is aggravated, so the breathing is short, the pulse is fast, and sometimes the upper abdominal muscles are nervous and are mistaken for peritonitis. However, the pain is carefully examined, the chest is carefully examined, and the abdominal lack of obvious and affirmative tenderness and rebound pain. Judgment, acute gastroenteritis, dysentery, etc. also have acute abdominal pain, nausea, vomiting, high fever, abdominal tenderness, etc., easy to mistaken for peritonitis, but a history of improper diet, abdominal tenderness is not heavy, no abdominal muscle tension, auscultation of bowel sounds enhanced Etc., all help to exclude the presence of peritonitis, other, such as acute pyelonephritis, diabetic ketotoxicosis, uremia, etc. can also have varying degrees of acute abdominal pain, nausea, vomiting and other symptoms, without the typical signs of peritonitis, as long as Analysis should be able to identify.

2, acute intestinal obstruction: most acute intestinal obstruction has obvious paroxysmal abdominal cramps, bowel sounds hyperthyroidism, abdominal distension, and no positive tenderness and abdominal muscle tension, easy to distinguish with peritonitis, but if the obstruction is not relieved, intestinal wall edema Stagnation of blood, intestinal peristalsis from hyperthyroidism to paralysis, clinical can appear weakened or disappeared, easy to be confused with peritonitis caused by intestinal paralysis, in addition to careful analysis of symptoms and signs, and through the abdominal X-ray and close observation, etc. If necessary, a laparotomy should be performed to be clear.

3, acute pancreatitis: edematous or hemorrhagic necrotizing pancreatitis have different symptoms and signs of peritoneal irritation, but not peritoneal infection; in the identification, serum or urinary amylase elevation is important, from the abdominal cavity puncture Determination of amylase values can sometimes confirm the diagnosis.

4, intra-abdominal or retroperitoneal hemorrhage: various causes of intra-abdominal or retroperitoneal hemorrhage, abdominal pain, abdominal distension, weakened bowel sounds and other clinical phenomena, but lack of tenderness, rebound pain, abdominal muscle tension and other signs, Abdominal radiographs, abdominal puncture and observation can often be diagnosed.

5, other: urinary calculi, retroperitoneal inflammation, etc. have their own characteristics, as long as the analysis, the diagnosis is not difficult.

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