Definition and classification
Acute Peritonitis is an inflammation of the peritoneum , diffuse , usually septic origin . Germs common are strep , pneumonia rarely gonorrhea or other germs. She is one of the major abdominal emergencies .
By way of penetration of the germ , peritonitis can be:
– Primitive ( spontaneous ) were extraperitoneal source of contamination and pathogen transport is about circular ;
– Secondary intraperitoneal contamination due .
After development , are:
⁃ acute ;
⁃ chronic .
After stretching injuries can be :
⁃ diffuse ;
After the appearance of exudate can be :
⁃ serous ;
⁃ fibrinous ;
⁃ purulent .
Etiopathogenical classification distinguishes peritonitis in : primary, secondary , tertiary and intraperitoneal abscesses .
a) Primary peritonitis is diffuse peritoneal infection that keeps the integrity of the digestive tract and related organs ;
b ) secondary peritonitis break in the digestive tract . Their causes : perforation of the stomach , duodenum , bile contamination , cecal peritonitis , peritonitis from acute pancreatitis , peritonitis genitourinary origin , postoperative and posttraumatic peritonitis , perforation of the intestine ;
c ) tertiary peritonitis are those where collection agent can not locate peritoneal irritation due to poor response of the body ;
d ) intraperitoneal abscesses are localized peritoneal infection .
Clinical and laboratory diagnosis
Clinical manifestations of acute diffuse peritonitis are
1) The pain of sudden onset may be slow onset rarely . Headquarters is at perforation pain as ” coup dagger ” pain is exacerbated by movement ;
2 ) vomiting are infrequent and occur later : initially food , bilious , and rarely faeces ;
3 ) Stopping erratic bowel is initially dynamic disturbances , then chances occlusion mecanoinflamatorie by agglutination ;
4 ) hiccups inconstant ;
5 ) High temperature 38 – 390c ;
6 ) Normal blood pressure initially , then decreases ;
7 ) Tachycardia ;
8 ) Shortness of breath and shallow breathing ;
9) Signs of shock : pallor , sweating , tachycardia ;
10 ) Position patient ” gun cock .”
11) On palpation there defense and abdominal contracture ;
12) On inspection – abs not breathing, costal breathing , coughing, painful ;
13) On percussion – sounding areas and abnormal dullness ;
14) On auscultation – Silentium abdomen.
Laboratory diagnosis is established on the account :
– Laboratory tests :
• White blood count reveals leukocytosis with relative lymphopenia ;
• urea is moderately high ;
• Urine examination reveals signs of severe impairment ;
• glucose – the upper limit .
– Empty abdominal radiograph reveals : pneumoperitoneum , bowel distention , dilated loops with the presence of air and liquid.
– Ultrasound reveals intraperitoneal collection ;
– Computer tomography and MRI is an excess for when the diagnosis was established ;
– Point peritoneal lavage ;
– Diagnostic Laparoscopy .
Treatment is surgical in most cases (except for primitive peritonitis ) . As with any surgical emergency , peritonitis requires a preoperative medical treatment , which has to be short and efficient .
Preoperative aims : fluid resuscitation , oxygen , antibiotics , pain killers and fever , renal support , ventilator and vasoactive (TA ) .
Surgery is necessary : eliminate the source of contamination, reduce contamination ( lavage , drainage ) , peritoneal lavage treatment of infections continue treatment by surgery, open abdomen , peritoneal drainage tube drainage . During resuscitation fluid resuscitation continues , oxygen , nasogastric suction probe , organ dysfunction , cephalosporin antibiotics , gentamicin , metronidazole .