Chronic peritonitis - Causes, Symptoms, Diagnosis and Treatment
Chronic peritonitis - Long flowing peritonitis, caused by the action of different reasons. There are several forms of pathology, which differ in clinical manifestations and treatments. Main symptoms: recurrent pain in the abdomen, dyspepsia, disorders stool, urination, weakness, fever, pale skin. Diagnosis is to collect anamnesis, external examination, a blood test, ultrasound, CT, MRI, X-ray of the abdomen, laparotomy. Medical and surgical treatment, appointed on an individual basis.
Chronic peritonitis
peritonitis - a sluggish, but has been steadily progressing infection or aseptic peritonitis, is a threat to the patient's life. According to the Statistics pathology occurs with a frequency of 005% to 0.3%. Despite medical advances, the problem of peritonitis does not lose its relevance. This is associated with high mortality rates, poorly understood pathogenesis. At the beginning of the twentieth century, mortality rates reached up to 80-100%, but in our time, thanks to modern medicines, operational assistance and adequate therapy, the figure is 15-19%. The main causes of the disease are inflammatory-destructive diseases of the abdominal cavity (approximately 80%), as well as complications from operations. This pathology is particularly difficult runs as a child and, according to some authors, 70% of the causes of sepsis and multiple organ failure in children.
tuberculosis less pneumococci and fungi (especially actinomycetes). But sometimes the disease can appear due to the aggressive action of body fluids (gastric juice secretion of the pancreas, blood, urine), chemical compounds, prolonged pressure and friction, contact with foreign objects that cause the development of aseptic inflammation. Scientific evidence shows that after about 6-8 hours of going on the accession of bacteria.
The pathogenetic mechanisms of development of peritonitis is not fully understood, but are important aspects of the following: the process of limiting the pathological focus, immune response, peritoneal function disorders, endotoxemia.
diffuse peritonitis (the latter almost always develops in acute processes).
Exudative type is characterized by the slow accumulation of serous fluid in the abdominal cavity, which sometimes reaches a considerable volume. Most often, patients are not able to specify the time of onset of the disease. In this form of markedly deteriorating general health, it develops weakness, rarely fever.
When the adhesive (adhesions, fibrous) peritonitis formed extensive adhesions and dense scar tissue bands. They are mostly associated with those bodies, where the duration of the inflammatory process occurs. Initially, pathology does not manifest itself, but when adhesions and bands hamper emptying of hollow organs (stomach, intestines, uterus, bladder) and disrupt their functions, developing clear clinical picture. Sharply deteriorating general condition, recorded dyspeptic symptoms (nausea, vomiting, bloating, change in stool). Appears a sharp pain in the abdomen, bowel obstruction, it becomes impossible to urinate, no menstruation, and so on. N.
Tuberculous peritonitis - a fairly rare phenomenon. It occurs in different forms, or a combination thereof: exudative to produce significant amounts of liquid and dry with the formation of tumor-like lump, ulcerative purulent with multiple spikes, which are located between the cheesy pockets of decay. Patients complain of recurrent abdominal pain. Fluid build-up leads to the development of shortness of breath while walking, palpitations, tension anterior abdominal wall. Gradually appears pale skin, fever, decreased body weight, impaired intestinal activity, increased sweating, decreased appetite.
Symptoms of local peritonitis due to localization, so allocate perigastrit, periduodenit, serocolitis, periholitsestit, perihepatitis and other pathology. Sometimes the disease is associated with a perforated body which covers the peritoneum, so do not develop acute events. Less inflammation is caused by friction and pressure on a specific area of the abdomen. The local process in clinical manifestations resembles adhesive peritonitis.
Gastroenterologist appoint additional methods of examination: blood test, ultrasound, CT, MRI and X-ray of the abdomen, diagnostic laparoscopy.
Blood test reveals leukocyte shift to the left, increasing the ESR, which are characteristic of chronic inflammation. Ultrasound, CT and MRI scans of the abdominal cavity in chronic peritonitis can detect inflammatory infiltrates, damage to internal organs. Do not be afraid to carry out X-ray with contrast medium, this method facilitates the early detection of insolvency and the anastomoses performed definition ileus. The most informative method of diagnosis - a laparoscopy. With its help, you can visually assess the state of peritoneal exudate and adhesions detected.
Gastroenterology. In general, measures aimed at removing the source of inflammation, restoration of the functions of the peritoneum and internal organs. It should be noted that the designation of analgesics are contraindicated as they lubricate clinical pathology and impaired intestinal motility, facilitating the spread of inflammation.
Drug treatment of the disease is the use of different drugs. As a rule, first using broad spectrum antibiotics, but if diagnosed tuberculous peritonitis, the specific anti-TB drugs are written. infusion solutions (glucose, saline, etc.) is used to restore the water and electrolyte balance and replenish lost fluids. To quickly remove toxins and bacteria from the body using detoxification, diuretic drugs. To restore bowel function, prescribed anticholinesterase drugs.
Surgical treatment of chronic peritonitis is not always carried out. When tuberculosis resistant form can achieve a positive result of conservative therapy, but if there are pockets of decay, it is necessary to eliminate them. The adhesive peritonitis require surgery (most often of laparotomy) to divide adhesions and remove the source of infection, but it is a high risk of recurrence of disease. Sometimes it is difficult to separate the adhesive conglomerate, so the type of operation is chosen individually. In exudative form in most cases enough to evacuate the liquid and the massive drug therapy. All patients displayed a balanced and rational diet.
Prognosis of the disease in a timely and adequate therapy is favorable, although postoperative peritonitis have a high rate of mortality (40%). Since mainly developed secondary chronic peritonitis, the prevention aimed at early detection and treatment of foci of infection, the prevention of postoperative complications, compliance with the recommendations of the attending physician, as well as organizing regular medical examination population.