acute suppurative peritonitis
Introduction
Introduction to acute suppurative peritonitis Acute suppurative peritonitis is divided into primary peritonitis and secondary peritonitis according to the pathogenesis. Primary peritonitis (also known as spontaneous peritonitis), no primary lesions in the abdominal cavity. The pathogens are mostly hemolytic streptococcus, pneumococci or Escherichia coli. Secondary peritonitis is the most common peritonitis, perforation of the hollow organs in the abdominal cavity, and abdominal wall or visceral rupture caused by trauma, which is the most common cause of acute secondary suppurative peritonitis. basic knowledge The proportion of illness: 0.025% Susceptible people: no specific population Mode of infection: non-infectious Complications: abdominal abscess, septic shock, acidosis
Cause
Causes of acute suppurative peritonitis
Primary peritonitis
The way bacteria enter the abdominal cavity is generally: blood line dissemination, ascending infection, direct spread, transmural infection.
2. Secondary peritonitis
Caused by perforation of the abdominal organs, inflammation, injury, rupture or surgical contamination. The main cause is acute appendicitis, followed by perforation of the stomach and duodenal ulcer. The most common pathogens are Escherichia coli, followed by anaerobic bacteria, enterococci, streptococci, and proteus.
Prevention
Acute suppurative peritonitis prevention
Life restraint pays attention to rest, work and rest, life is orderly, and maintaining an optimistic, positive and upward attitude towards life is of great help in preventing diseases. Do the regularity of tea and rice, live daily, not overworked, open-minded, and develop good habits.
Complication
Acute suppurative peritonitis complications Complications, abdominal abscess, septic shock acidosis
Abdominal abscess, septic shock, acidosis
Symptom
Acute suppurative peritonitis symptoms Common symptoms Shortness of breath, cleft lip, abdominal pain, nausea and vomiting, infectious fever, dry mouth
(a) symptoms
Abdominal pain
Abdominal pain is the most important symptom, the degree varies with the degree of inflammation, but it is generally very intense, unbearable, and persistent. Deep breathing, coughing, and turning the body can aggravate the pain, so the patient does not change position. The pain started from the original lesion, and the inflammation spread and spread throughout the abdomen, but the original lesion was still more prominent.
2. nausea, vomiting
This is a common symptom that occurs early. At the beginning, due to stimulation of the peritoneum, reflex nausea and vomiting are caused, and vomit is the contents of the stomach. When paralyzed intestinal obstruction occurs later, the vomit turns into a yellow-green biliary sap, or even a tan fecal-like intestinal contents. Due to frequent vomiting, severe dehydration and electrolyte imbalance can occur.
3. fever
At the beginning, the body temperature can be normal, and then gradually increase. In elderly patients with debilitation, body temperature does not necessarily increase as the condition worsens. The pulse usually speeds up as the body temperature increases. If the pulse increases and the body temperature falls, it is mostly a sign of worsening the condition, and effective measures must be taken as soon as possible.
4. Symptoms of infection poisoning
When peritonitis enters a serious stage, it often shows systemic poisoning such as high fever, sweating, dry mouth, fast pulse, and shallow breathing. In the later stage, due to the absorption of a large amount of toxins, the patient showed apathy, facial paralysis, eye socket depression, lip cyanosis, cold limbs, dry yellow tongue, dry skin, shortness of breath, weak pulse, sudden rise or fall in body temperature, decreased blood pressure, shock, acid Poisoned. If the condition continues to worsen, it will eventually die due to liver and kidney dysfunction and respiratory and circulatory failure.
(two) signs
1. Abdominal breathing is weakened or disappeared, accompanied by significant abdominal distension. Aggravation of abdominal distension is often an important indicator of the development of the disease.
2. Muscle tension, tenderness, and rebound tenderness are important signs of peritonitis. They are always present, usually throughout the abdomen and most prominent in the primary lesion. The degree of abdominal muscle tension varies depending on the cause and the general condition of the patient.
3. Abdominal percussion can be drum sound due to flatulence. When the gastrointestinal tract is perforated, the heart and liver dullness often shrinks or disappears during percussion. When there is too much fluid in the abdominal cavity, mobility dullness can be extracted.
4. Auscultation often finds that the bowel sounds are weakened or disappeared.
5. In the rectal examination, if the rectal anterior fossa is full and tender, it indicates that there is a pelvic infection.
Examine
Examination of acute suppurative peritonitis
Laboratory examination
White blood cell count and neutrophil ratio increased, or poisoned particles.
2. X-ray inspection
The small intestine is generally flatulent, and there are multiple signs of intestinal paralysis in the small liquid level; most of the free gas in the axilla is visible in the gastrointestinal perforation.
3.B-ultrasound
It can show that there is fluid in the abdomen, which is helpful for the diagnosis of primary disease.
4. Diagnostic abdominal puncture or peritoneal lavage
Abdominal puncture can determine the original mutiny. Defining the cause, such as gastroduodenal ulcer perforation, the puncture fluid is yellow, turbid, no odor, and sometimes the food residue can be extracted; in acute severe pancreatitis, the extract is bloody, and the content of pancreatic amylase is high. If the abdominal cavity puncture is not coagulated, it indicates that there is a parenchymal organ damage. When the intraperitoneal fluid is less than 100ml, the abdominal puncture often does not draw liquid, and a certain amount of physiological saline is injected and then the liquid is inspected.
Diagnosis
Diagnosis and diagnosis of acute suppurative peritonitis
Diagnosis is based on symptoms, signs and tests.
Differential diagnosis:
1. 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: edematous or hemorrhagic necrotizing pancreatitis have mild and severe peritoneal irritation symptoms and signs, but not peritoneal infection; in the identification, serum or urinary amylase elevation is important, from abdominal cavity puncture Determination of amylase values can sometimes confirm the diagnosis.
