What are Treatments for Peritonitis?

Peritonitis is a serious disease common in surgery caused by bacterial infections, chemical irritation, or injury. Most of them are secondary peritonitis, which are caused by organ infection in the abdominal cavity, perforation of necrosis, and trauma. Its main clinical manifestations are abdominal pain, abdominal muscle tension, and nausea, vomiting, and fever. In severe cases, it can cause blood pressure drop and systemic toxic reactions. If it is not treated in time, it can die from toxic shock. Some patients may be complicated by pelvic abscess, intestinal abscess and subcondylar abscess, popliteal abscess, and adhesive intestinal obstruction.

Basic Information

English name

peritonitis

Visiting department

surgical

Common causes

Secondary peritonitis originates from organ infection, necrosis, perforation, trauma, etc. in the abdominal cavity

Common symptoms

Abdominal pain, abdominal muscle tension, nausea, vomiting, fever, severe systemic toxic reactions in severe cases

Contagious

no

Causes of peritonitis

Primary peritonitis

Rarely clinically, refers to the absence of primary lesions in the abdominal cavity. Pathogens are caused by peritonitis caused by infection of the abdominal cavity through blood circulation, lymphatic pathways, or the female reproductive system.

2. Secondary peritonitis

It is the most common peritonitis clinically, secondary to organ perforation in the abdominal cavity, injury and rupture of organs, inflammation and surgical pollution. The main causes are perforating appendicitis, acute perforation of gastric and duodenal ulcers, acute cholecystitis transmural infection or perforation, typhoid intestinal perforation and acute pancreatitis, female reproductive organ purulent inflammation or postpartum infection, and other exudates containing bacteria. Entering the abdominal cavity causes peritonitis.

Clinical manifestations of peritonitis

The main clinical manifestations of peritonitis are early symptoms of peritoneal irritation, such as abdominal pain, abdominal muscle tension and rebound pain. In the later period, due to infection and toxin absorption, the main symptoms are systemic infection and poisoning.

Abdominal pain

This is the main symptom of peritonitis. But generally it is intense, unbearable, and persistent. Breathing deeply, coughing, and aggravating pain when turning your body. Therefore, the patient cannot change his position. Most of the pain starts from the primary lesion, and spreads to the whole abdomen after the inflammation spreads, but the primary lesion is still the most significant.

2. Nausea and vomiting

This is a common symptom that appears early. At the beginning of the peritoneal irritation caused reflex nausea and vomiting, and the vomit was stomach contents. In the later stage of paralytic intestinal obstruction, the vomitus turns yellow-green and even tan fecal-like intestinal contents.

3. Fever

Sudden onset of peritonitis can be normal at the beginning and gradually increase thereafter. The temperature of elderly debilitated patients does not necessarily increase with the worsening of their condition. Pulse usually speeds up with increasing body temperature.

4. infection poisoning

When peritonitis enters a severe stage, systemic poisoning such as high fever, dry mouth, fast pulses, and shortness of breath often occur. In the later period, due to the absorption of a large amount of toxins, the patients were indifferent expressions, emaciated faces, sunken sockets, cyanosis of the lips, cold limbs, dry yellow tongue, dry skin, shortness of breath, weak pulse, sharp rise or fall in body temperature, decreased blood pressure, shock, acidosis.

5. Abdominal signs

Appears as abdominal breathing weakened or disappeared, accompanied by significant abdominal distension. Tenderness and rebound pain are the main signs of peritonitis, and they are always present, usually the most prominent part of the entire abdomen.

Peritonitis examination

The white blood cell count increased, but the white blood cell count was not high when the condition was severe or the body responded poorly. Only the neutrophil percentage increased or toxic particles appeared. X-ray examination of the abdomen shows that the intestinal cavity is generally flatulent, and there are multiple signs of intestinal paralysis such as small gas-liquid levels; most of the free gas under the diaphragm is present during gastrointestinal perforation, which is of great significance in diagnosis. Patients with weak constitution, or patients who cannot stand for fluoroscopy due to shock, can perform side-by-side filming and can also show the presence of free gas.

Peritonitis diagnosis

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

Primary peritonitis often occurs during respiratory infections in children, children with sudden abdominal pain, vomiting, diarrhea, and obvious abdominal signs appear, the condition develops rapidly. The causes of secondary peritonitis are many. As long as the patient's history is combined with various examinations and signs for comprehensive analysis, the diagnosis can be made. The degree of abdominal muscles does not necessarily reflect the severity of intra-abdominal lesions.

If further auxiliary examination is needed during diagnosis. Such as anal finger examination, pelvic examination, diagnostic abdominal cavity in the lower semi-recumbent position and female posterior fornix puncture examination. The cause of the disease is determined based on the color, odor, nature, and microscopic examination of the smear, or quantitative determination of the amylase value. Can also be used for bacterial culture. If the peritoneal fluid is below 100ml, the diagnosis of abdominal puncture is not easy. In order to make a clear diagnosis, a diagnostic peritoneal lavage is feasible, which will provide reliable data for a clear diagnosis. For cases where the etiology is difficult to determine and there are certain surgical guidelines, laparotomy should be performed as soon as possible in order to find and process the original lesion in time.

Differential diagnosis of peritonitis

Pneumonia, pleurisy, pericarditis, coronary heart disease, etc. can cause reflex abdominal pain, and pain can also be exacerbated by respiratory activity. Acute gastroenteritis, dysentery, etc. also have acute abdominal pain, nausea, vomiting, high fever, abdominal tenderness, etc., which is easily mistaken for peritonitis. However, a history of improper diet, mild abdominal tenderness, no abdominal muscle tension, and auscultation of bowel sounds all help to rule out the presence of peritonitis. Others, such as acute pyelonephritis, diabetic ketoacidosis, and uremia, can also have symptoms of acute abdominal pain, nausea, and vomiting to varying degrees, without the typical signs of peritonitis.

Acute intestinal obstruction

Most acute intestinal obstructions have obvious paroxysmal abdominal cramps, hyperactive bowel sounds, and abdominal distension, without certain tenderness and abdominal muscle tension, which can be easily distinguished from peritonitis. However, if the obstruction is not relieved, intestinal wall edema and congestion, intestinal peristalsis changes from hyperactivity to paralysis, clinical sounds may weaken or disappear, which is easily confused with peritonitis caused intestinal paralysis. In addition to careful analysis of symptoms and signs, and distinguished by abdominal X-rays and close observation, if necessary, a laparotomy is required to be clear.

2. Acute pancreatitis

Edema or hemorrhagic and necrotizing pancreatitis have peritoneal irritation symptoms and signs of varying severity, but not peritoneal infection; in the identification, serum or urinary amylase elevation is of great significance. The amylase value is sometimes measured from the abdominal puncture Can definitely diagnose.

3. Intraperitoneal or retroperitoneal hemorrhage

Intra-abdominal or retroperitoneal hemorrhage caused by various etiologies may cause clinical symptoms such as abdominal pain, bloating, and weakening of bowel sounds, but lack of signs such as tenderness, rebound pain, and abdominal muscle tension. Abdominal X-rays, punctures, and observations often make a clear diagnosis.

4. Other

Because urinary calculi and retroperitoneal inflammation have their own characteristics, as long as they are analyzed carefully, the diagnosis is not difficult.

Peritonitis treatment

In principle, the treatment is to actively eliminate the cause of peritonitis, and thoroughly wash away the pus and exudate existing in the abdominal cavity, or promote the absorption and limitation of the exudate as soon as possible. Or disappear through drainage. In order to achieve the above purpose, different treatment measures should be taken according to different etiology, stage of disease, and patient's physique. The treatment of peritonitis can be divided into two types: non-surgical treatment and surgical treatment.

(I) Non-surgical treatment

Body position

When there is no shock, the patient should take a semi-recumbent position to facilitate drainage. In the semi-recumbent position, often move both lower limbs and change the compression site to prevent venous thrombosis and pressure ulcers.

2. Fasting

Patients with gastrointestinal perforation must be absolutely fasted to reduce continued leakage of gastrointestinal contents.

3. Gastrointestinal decompression

Can reduce gastrointestinal swelling, improve blood flow in the gastrointestinal wall, and reduce leakage of gastrointestinal contents into the abdominal cavity through the breach.

4. Intravenous crystal colloid fluid

Patients with fasting to peritonitis must have an infusion to correct water-electrolyte and acid-base disorders. For patients with severe failure, extra blood, plasma, and albumin should be transfused to supplement the protein lost due to exudation of the abdominal cavity to prevent hypoproteinemia and anemia.

5. Calories and nutrition

Peritonitis requires a lot of calories and nutrition to make up for its needs. Compound amino acid solution should be given to reduce the consumption of protein in the body. For patients who cannot eat for a long time, deep vein hypernutrition treatment should be considered.

6. Application of antibiotics

Large-dose broad-spectrum antibiotics should be used early, and then adjusted based on the results of bacterial culture. Choose sensitive antibiotics, such as chloramphenicol, clindamycin, metronidazole, gentamicin, ampicillin, and so on. For gram-negative bacillus sepsis, the third-generation cephalosporins can be used, such as bacteriostasis.

7. Analgesia

For patients with a well-defined diagnosis and established treatment, dolentine or morphine can be used to relieve pain. However, if the diagnosis has not been determined and the patient still needs observation, analgesics should not be used to avoid covering the condition.

(B) surgical treatment

Lesion treatment

The earlier the surgical removal of the source of infection, the better the patient's prognosis. In principle, the surgical incision should be closer to the site of the lesion. The better is a straight incision, which is convenient to extend up and down, and is suitable for changing the surgical method.

2. Clean up the abdominal cavity

After eliminating the cause, the abdomen in the abdominal cavity should be exhausted as much as possible, and the food and residues, feces, and foreign bodies in the abdominal cavity should be removed.

3. Drainage

The purpose is to make the exudate that continues to be produced in the abdominal cavity drain out of the body through the drainage, so that the remaining inflammation can be controlled, limited and disappeared. Prevent the occurrence of abdominal abscess. Diffuse peritonitis generally requires no drainage as long as it is cleaned. However, abdominal drainage must be placed in the following cases: the necrotic lesions cannot be completely removed or a large amount of necrotic material cannot be removed; there is more exudation or bleeding at the surgical site; a localized abscess has formed.

Prognosis of peritonitis

Due to the improvement of diagnosis and treatment, the prognosis of acute peritonitis has improved compared with the past, but the mortality rate is still 5% -10%. Primary peritonitis that occurs on the basis of cirrhosis and ascites is as high as 40%. Delayed diagnosis and delayed treatment, children, the elderly, and those with heart, lung, kidney disease and diabetes have a poor prognosis.

Peritonitis prevention

Early and appropriate treatment of inflammatory diseases in the abdominal cavity that may cause peritonitis is a fundamental measure to prevent peritonitis. Any abdominal surgery or even abdominal puncture should be strictly performed aseptically. Antibacterial drugs should be given orally before bowel surgery to reduce the incidence of peritonitis.