Acute peritonitis

Introduction to acute peritonitis Acute peritonitis (acuteperitonitis) 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, causing acute inflammatory reactions, mostly by bacterial infection, chemical stimulation or physical damage. Caused by. Most of them are secondary peritonitis, which originates from abdominal organ infection, necrotic perforation, and trauma. Its typical clinical manifestations are triad of peritonitis - abdominal tenderness, abdominal muscle tension and rebound tenderness, as well as abdominal pain, nausea, vomiting, fever, elevated white blood cells, etc., when severe, can cause blood pressure drop and systemic toxicity, if not timely Treatment can die from toxic shock. Some patients may have complications such as pelvic abscess, intestinal abscess, and underarm abscess, axillary abscess, and adhesive intestinal obstruction. basic knowledge The proportion of illness: 0.013% Susceptible people: no special people Mode of infection: non-infectious Complications: septic shock, acute perforation of ulcer disease

Cause of acute peritonitis

Acute perforation (20%):

Acute perforation and rupture of the abdominal organs occur mostly in organs with existing lesions. The perforation of hollow organs often occurs suddenly due to the progression of ulcers or gangrenous lesions, for example, acute appendicitis, peptic ulcer, acute cholecystitis, typhoid ulcer , gastric or colon cancer, ulcerative colitis, ulcerative intestinal tuberculosis, amoebic bowel disease, diverticulitis and other perforations leading to acute peritonitis, parenchymal organs such as liver, spleen, can also be broken due to abscess or cancer.

Acute infection (20%):

The spread of acute infection of the abdominal organs such as acute appendicitis, cholecystitis, pancreatitis, diverticulitis, ascending infection of the female reproductive tract (such as puerperal fever, salpingitis), etc., can spread to the peritoneum to cause acute inflammation.

Acute intestinal obstruction (20%):

Intestinal intussusception, incarcerated hernia, mesenteric vascular embolization or thrombosis caused by strangulated intestinal obstruction, due to intestinal wall damage, loss of normal barrier function, intestinal bacteria can invade the abdominal cavity through the intestinal wall, resulting in peritonitis.

Abdominal trauma (15%):

When the bullet passes through the abdominal wall, it can penetrate the hollow organ or introduce external bacteria into the abdominal cavity. The abdominal injury can sometimes cause the internal organs to rupture, resulting in acute peritonitis. During abdominal surgery, the bacteria can be brought to the outside due to poor sterilization. Abdominal cavity; may also cause local infection spread due to inadvertent surgery, or suture leakage of stomach, intestine, gallbladder, pancreas, sometimes due to abdominal puncture drainage or neglecting aseptic operation during peritoneal dialysis, can cause acute peritonitis s consequence.

Hematogenous disseminated infection (10%):

Can cause primary acute peritonitis. The most common bacteria in peritoneal infections are Escherichia coli, Enterococcus, Pseudomonas aeruginosa, Proteus, Gastrobacter oxysporum and other anaerobic bacteria, which are mixed infections in most cases.

Acute peritonitis prevention

Early treatment of intraperitoneal 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 procedures. Antibiotics should be given orally before bowel surgery. The occurrence of peritonitis.

Acute peritonitis complications Complications , acute perforation of septic ulcer disease

In severe cases, it can cause blood pressure drop and systemic toxicity. If it is not treated in time, it can die of toxic shock. Some patients may have complications such as pelvic abscess, intestinal abscess, and underarm abscess, axillary abscess, and adhesive intestinal obstruction.

Acute symptoms of peritonitis Common symptoms Persistent pain Leukocytosis Acute abdominal pain Peritoneal irritation Abdominal muscle twitch Mobility Voiced Yinchang Abdominal pain Skin dry peritonitis

The main clinical manifestations of acute peritonitis include abdominal pain, abdominal tenderness and abdominal muscle tension, often accompanied by nausea, vomiting, bloating, fever, hypotension, rapid pulse, shortness of breath, leukocytosis and other poisoning phenomena. A complication of the disease, so the symptoms of the primary disease often occur before and after the onset.

(a) symptoms

1. Acute abdominal pain: Abdominal pain is the most common and most common symptom. Most of them occur suddenly, persist and rapidly expand. The nature depends on the type of peritonitis (chemical or bacterial), the scope of inflammation and the reaction of patients, stomach, When the duodenum, gallbladder and other organs are acutely worn to cause diffuse peritonitis, the digestive juice stimulates the peritoneum, which suddenly produces strong abdominal pain, and even produces so-called peritoneal shock. In a few cases, the peritoneum can be caused before the bacterial secondary infection occurs. Exudation of a large amount of fluid, dilution of irritants, and the occurrence of abdominal pain and peritoneal irritation temporarily relieved the dysfunction of the disease; when secondary bacterial infection, abdominal pain is again intensified, peritonitis caused by bacterial infection generally first with primary lesions (such as appendicitis, Local pain in cholecystitis, etc., abdominal pain is relatively slow when perforating, showing pain or dull pain, unlike the stomach, the acute gallbladder is severely pierced, and the pain gradually increases and spreads from the lesion area to the whole abdomen. Different from person to person, some patients complain of abnormally severe persistent pain, others only report dull pain or discomfort, and weak or elderly patients, Shigeatsu typhoid patients in acute pain may not be perforated.

2, nausea and vomiting: in order to appear very early common symptoms, began to be due to peritoneal irritation, nausea and vomiting is reflexive, sometimes no, spit out for stomach contents, sometimes with bile; later due to paralytic ileus, vomiting It becomes persistent without nausea, and the spit is a brownish intestine content, which may have a bad smell.

3, other symptoms: in the acute perforation of the hollow organ to produce peritonitis, due to peritoneal shock or toxemia, collapse phenomenon is common, when the body temperature is lower than normal or near normal; when the collapse of the collapse and peritonitis continue to develop, the body temperature begins Gradually increase, if the primary disease is acute infection (such as acute appendicitis and acute cholecystitis), in the case of acute peritonitis, the body temperature is often higher than the original, in the case of acute diffuse peritonitis, due to peritoneal exudation of large amounts of fluid, peritoneum and intestine The wall is highly congested, edema, paralyzed intestinal cavity accumulates a large amount of fluid, plus vomiting and water loss, etc., effective circulating blood volume and total amount of blood potassium are significantly reduced. In addition, due to decreased renal blood flow, toxemia is aggravated, heart, kidney And peripheral vascular function impairment, patients often have hypotension and shock performance, pulse breakdown or can not be combined, but also thirst, oliguria or no urine, bloating, no anal exhaust, and sometimes frequent hiccups, the reasons It may be that inflammation has spread to the diaphragm.

(two) signs

Peritonitis patients have painful expressions, coughing, breathing, turning the body can make abdominal pain worse, patients are forced to take supine position, flexion of both lower limbs, respiratory frequency, in the late stage of toxemia, due to high fever, not eating, losing water In the case of acidosis, the central nervous system and various vital organs are in a state of inhibition. At this time, the patient presents with depression, body cold, pale complexion, dry skin, eyeball and cheeks invagination, nose sharpening, and cold sweat. .

Abdominal examination can be found in the typical triad of peritonitis - abdominal tenderness, abdominal wall muscle spasm and rebound tenderness, in localized peritonitis, three are confined to one part of the abdomen, and in diffuse peritonitis, throughout the abdomen, and can be seen Abdominal breathing becomes shallow, abdominal wall reflex disappears, bowel sounds decrease or disappear, tenderness and rebound tenderness almost always exist, and the degree of abdominal wall muscle spasm is inconsistent with the patient's general condition, usually in acute perforation of peptic ulcer, abdominal wall muscle It is straight and straight, and in the case of extreme debilitation such as intestinal typhoid perforation or toxemia, the abdominal muscle spasm or tonic signs can be mild or absent. When there is a lot of exudate in the abdominal cavity, the mobile dullness can be detected. When the gastro-intestinal perforation causes the gas to be free in the abdominal cavity, the liver dullness area of about 55-60% of the cases shrinks or disappears. When the inflammation is limited, a localized abscess or inflammatory mass is formed and the abdominal wall is near, the lumps may be unclear. In the pelvic mass or abscess can sometimes be diagnosed by rectal examination.

Examination of acute peritonitis

1, white blood cell count and neutrophil ratio are generally significantly increased, and common nuclear left shift and poisoning particles, in patients with severe diffuse peritonitis due to a large number of white blood cells infiltrated into the abdominal cavity, the number of white blood cells in the surrounding blood may not be high, but neutral The proportion of granulocytes is still high, as is aging or immunocompromised.

2, urine routine examination, urine is concentrated due to loss of water, protein and tube type can appear, urinary ketone can be positive.

3, blood biochemical examination can be found in acidosis and electrolyte imbalance.

4, abdominal cavity exudate culture often get pathogenic bacteria.

5. X-ray inspection can show the gas under the armpit.

Diagnosis and differentiation of acute peritonitis

diagnosis

According to typical symptoms and signs, white blood cell count and classification, abdominal X-ray examination, B-ultrasound examination and CT examination, the diagnosis of acute peritonitis is generally not difficult.

Auxiliary inspection

Abdominal puncture: It is a simple, easy and economical examination method. If you can get the intra-abdominal fluid, you can judge whether there is peritonitis and what type of peritonitis by the naked eye, plus microscopic examination, bacterial smear and necessary Biochemical tests (such as amylase assay) have a higher diagnostic value.

Tuberculous peritonitis is grass green transparent ascites. When the gastric duodenum is acutely perforated, the extract is yellow, turbid, contains bile, and has no odor. When perforated, it may contain food residue. In acute severe pancreatitis, the extract is bloody. The content of pancreatic amylase is high. When the appendicitis is perforated, the extract is slightly purulent and slightly odorous. The narrower intestinal obstruction is bloody and odorous. If the abdomen is completely fresh, it is considered as intraperitoneal. Substantial organ damage, and the exclusion of organs or blood vessels.

For secondary peritonitis, the location of the primary lesion should be determined to consider further treatment. However, it is sometimes difficult when the signs of peritonitis are obvious. In general, X-ray examination shows a gastrointestinal perforation when the free gas is underarm. If the symptoms of gastrointestinal decompression and initial treatment are not improved, the possibility of gallbladder perforation should be considered. Female patients should consider salpingitis and ovarian inflammation. Elderly patients should consider the possibility of colon cancer or diverticulum perforation.

Pleurisy, pneumonia, etc. can cause fever, upper abdominal pain, acute myocardial infarction can have severe upper abdominal pain. Acute pancreatitis, peri-renal abscess, and even herpes zoster can also cause fever and abdominal pain. However, according to medical history, physical signs and corresponding examinations, it is not difficult to identify.

Differential diagnosis

The symptoms and signs of primary peritonitis are similar to those of secondary peritonitis, and the results of laboratory tests are similar. However, only non-surgical treatment can be different from secondary peritonitis. Therefore, attention should be paid to identification. The main points of identification of primary peritonitis and secondary peritonitis are as follows:

1, primary peritonitis is mainly seen in patients with cirrhosis ascites, nephrotic syndrome and other immune dysfunction and infants, especially girls under 10 years of age. Most secondary peritonitis does not have such limitations.

2, primary peritonitis occurs in patients with cirrhosis ascites, the onset of the "peritonitis triad" is often not obvious. Primary peritonitis occurs in infants and young children, and the onset of "peritonitis triad" is also less than secondary peritonitis.

3, no primary infection in the abdominal cavity is the key to distinguish between primary peritonitis and secondary peritonitis. X examination found that underarm free gas is evidence of secondary peritonitis.

4, abdominal puncture, take ascites or peritoneal exudate for bacterial smear and culture examination. Primary peritonitis is a single bacterial infection and secondary peritonitis is almost a mixed bacterial infection.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.