Peritonitis

Introduction Peritonitis is a serious disease common to surgery caused by bacterial infections, chemical stimuli or injuries. Most of them are secondary peritonitis, which originates from abdominal organ infection, necrotic perforation and trauma. 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.

Cause

Primary peritonitis

It is rare in clinical practice. It means that there is no primary lesion in the abdominal cavity. The pathogen is peritonitis caused by infection of the abdominal cavity through blood circulation, lymphatic route or female reproductive system.

2. Secondary peritonitis

It is the most common peritonitis in the clinic, secondary to perforation of organs in the abdominal cavity, damage to organs, inflammation, and surgical contamination. The main causes are perforation of appendicitis, acute perforation of stomach and duodenal ulcer, transmural infection or perforation of acute cholecystitis, perforation of typhoid and intestinal perfusion, acute pancreatitis, purulent inflammation of female reproductive organs or postpartum infection and other bacterial-containing exudates Entering the abdominal cavity causes peritonitis.

an examination

According to the history of abdominal pain, combined with typical signs, white blood cell counts and abdominal X-ray examination, it is generally not difficult to diagnose peritonitis.

Primary peritonitis often occurs during childhood respiratory infections, sudden abdominal pain, vomiting, diarrhea, and obvious abdominal signs, and the disease develops rapidly. The causes of secondary peritonitis are many. As long as the medical history is combined with various examinations and signs for comprehensive analysis, the degree of abdominal muscles does not necessarily reflect the severity of intra-abdominal lesions.

Further auxiliary examination is required if diagnosed. Such as anal finger examination, pelvic examination, diagnostic abdominal cavity in the lower semi-recumbent position and post-menopausal puncture examination. The cause of the disease is determined based on the color, odor, properties, smear microscopy, or quantitative determination of the amylase value of the liquid obtained by the puncture. It can also be used for bacterial culture. Diagnostic abdominal wear is not successful if the peritoneal fluid is below 100 ml. For a definitive diagnosis, a viable diagnostic abdominal flush will provide reliable information for a definitive diagnosis. For cases where the cause is difficult to determine and there is a positive surgical indication, laparotomy should be performed as soon as possible to detect and treat the primary lesion in time.

Differential diagnosis

Pneumonia, pleurisy, pericarditis, coronary heart disease, etc. can cause reflex abdominal pain, and pain can be aggravated by respiratory activity. Acute gastroenteritis, dysentery, etc. also have acute abdominal pain, nausea, vomiting, high fever, abdominal tenderness, etc., easily mistaken for peritonitis. However, the history of improper diet, abdominal tenderness, no abdominal muscle tension, and auscultation of bowel sounds are all helpful in eliminating the presence of peritonitis. Others, such as acute pyelonephritis, diabetic ketoacidosis, uremia, etc. can also have different degrees of acute abdominal pain, nausea, vomiting and other symptoms, without the typical signs of peritonitis.

Acute intestinal obstruction

Most acute intestinal obstruction has obvious paroxysmal abdominal cramps, hyperactivity of bowel sounds, abdominal distension, and no positive tenderness and abdominal muscle tension, easy to distinguish with peritonitis. However, if the obstruction is not relieved, the intestinal wall edema and congestion, intestinal peristalsis from hyperthyroidism to paralysis, clinical can appear weakened or disappeared, easy to be confused with peritonitis caused intestinal paralysis. In addition to careful analysis of symptoms and signs, and to distinguish by abdominal X-ray and close observation, if necessary, laparotomy should be performed to be clear.

2. Acute pancreatitis

Edema or hemorrhagic necrotizing pancreatitis have symptoms and signs of peritoneal irritation ranging from mild to severe, but not peritoneal infection. In the identification, serum or urinary amylase elevation is important, and the determination of amylase value from the peritoneal puncture can sometimes confirm the diagnosis.

3. Intra-abdominal or retroperitoneal hemorrhage

Various causes of intra-abdominal or retroperitoneal hemorrhage, clinical symptoms such as abdominal pain, abdominal distension, and weakened bowel sounds may occur, but there are signs such as tenderness, rebound tenderness, and abdominal muscle tension. Abdominal X-ray, abdominal puncture and observation can often confirm the diagnosis.

4. Other

Urinary calculi, retroperitoneal inflammation, etc., have their own characteristics, as long as the analysis is fine, the diagnosis is not difficult.

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