How does peritonitis develop?
Normally, there is only a little fluid in the abdominal cavity, and the peritoneum remains sterile. When the contents of the intestines, stomach, bile or pus enter it, violent inflammation begins. The peritoneum responds by releasing a large amount of fluid, which leaves the bloodstream: dehydration develops and pressure drops. Microbes and their toxins are absorbed through the huge surface of the peritoneum, causing intoxication. The intestines stop contracting, gases and liquid accumulate in its lumen, and the stomach swells. Without surgery, the process becomes uncontrollable.
- Entry of infected contents into the abdominal cavity
- Massive loss of fluid into the abdominal cavity
- Absorption of toxins and intoxication
- Intestinal paralysis and bloating
- Impaired functioning of the kidneys, lungs and heart
Main reasons
The most common cause is acute appendicitis, in which the appendix ruptures and pus flows into the abdominal cavity. Next in frequency are perforated ulcers of the stomach and duodenum, destructive cholecystitis, inflammation of colon diverticula, intestinal obstruction with necrosis of the wall, and pancreatic necrosis. In women, the cause is purulent inflammation of the uterine appendages. A separate group includes abdominal injuries and complications after operations when the tightness of the sutures is broken. People with cirrhosis of the liver have primary peritonitis without organ rupture.
- Acute appendicitis with breakthrough
- Perforated ulcer of the stomach and duodenum
- Destructive cholecystitis
- Colon diverticulitis
- Intestinal obstruction and pancreatic necrosis
- Abdominal injuries and surgical complications
- Primary peritonitis in liver cirrhosis
Symptoms by stage
First, the pain is localized where the diseased organ is located, and then it becomes diffuse and constant, intensifying with movement, coughing and trying to straighten up. The person lies motionless, often on his side with his legs pulled up to his stomach. The abdomen is tense, and when pressing and especially when suddenly releasing the hand, the pain increases sharply. The temperature rises, chills, dry mouth, thirst, and rapid pulse appear. In the late stage, a deceptive calm sets in: the pain decreases due to the death of nerve endings, but the condition worsens sharply, the abdomen is swollen, and vomiting becomes constant.
- Diffuse constant abdominal pain
- Muscle tension in the anterior abdominal wall
- Increasing pain when suddenly releasing the hand
- Dry mouth, thirst, rapid pulse
- Bloating and loss of gas
- Imaginary improvement in late stage
Do's and Don'ts
If you suspect peritonitis, you should immediately call an ambulance at 103. Until the doctor arrives, you should not eat or drink, take painkillers and antispasmodics, put a heating pad on your stomach, give an enema or rinse your stomach. Painkillers are especially dangerous: they reduce pain and muscle tension, which can cause the doctor to underestimate the severity of the condition, and time will be lost. You are allowed to lie down in a comfortable position and apply cold to your stomach. It is important to tell your doctor when the pain started, whether there was vomiting and fever.
- Call 103 for help immediately
- Don't eat or drink
- Do not take painkillers and antispasmodics
- Do not warm the stomach, you can apply cold
- Don't give an enema
- Remember the time of onset of pain and all symptoms
Diagnosis and treatment
The diagnosis is largely made by examination: the doctor assesses tension in the abdominal wall and special signs of peritoneal irritation. Plain radiography shows free gas under the diaphragm when a hollow organ is perforated; ultrasound and CT scans reveal fluid and the source of inflammation. Blood tests show high levels of leukocytes, CRP and procalcitonin. Surgical treatment: an operation during which the source is eliminated, the abdominal cavity is washed and drained. At the same time, antibacterial and intensive therapy is carried out, fluid is replenished and organs are supported.
- Examination by the surgeon and signs of peritoneal irritation
- Survey radiography - free gas
- Ultrasound and CT scan of the abdominal cavity
- Complete blood count, CRP, procalcitonin
- Emergency surgery with abdominal sanitation
- Antibiotics and intensive care
