The article was consulted professionally by ThS.BS Vu Van Quan – General Department of General Medicine – Anesthesia, Share99 Hai Phong International Health Hub. The doctor has more than 10 years of experience working in General Digestive Foreign Affairs.
Acute peritonitis is a serious pathology, if not intervened in time the patient will be at high risk of death. Acute peritonitis surgery should be performed as soon as possible on the basis of active resuscitation.
1. Causes of acute peritonitis
The peritoneum is the largest peritoneal membrane in the body, composed of the leaves and organ leaves. The leaves are lined with the inner side of the abdominal wall and pelvic wall. Organ leaves cover the organs in the abdomen. The space between the city leaves and the organ leaves is called the mescosa. The mesitoneal drive contains a little volume, which has the effect of reducing contact between the muscles. Theitoneium has an important function of enveloping and sheltering organs, when there is infection, theitoneium tends to be surrounded by walls to shelter the bacterial outbreak.
Peritonitis is an inflammation of the peritoneal leaves, often caused by bacterial infections or fungal infections. According to the course of the disease, peritonitis can be divided into total acute peritonitis and resident peritonitis. According to the encecencephal cause of the disease, it can be divided into acute peritonitis and second-party peritonitis.
- Purulent peritonitis: accounts for only about 1% of cases of acute peritonitis, which is common in children under 10 years of age that rarely appear in adults. The mesitoneum damages itself from the beginning due to agents such as tuberculosis, pneumococcal, sjunctivoccal bacteria,.. These causes enter the peritonetus by blood sugar, lymphatic sugar, without organ damage in the abdomen.
- Second peritonitis: It is usually caused by an infected abdominal organ that diffuses or ruptures. Second-degree peritonitis accounts for 99% of clinical cases of upper peritonitis. The peritoneum is infected with many coordinated bacteria, usually E.coli, Klebsiella pneumoniae, B.flagilis, Streptococcus, Enterococcus, Clostridium,…
Common secondary peritonitis encephalitis: Ruptured appendicitis, perforation of the appendix, perforation of the duodenal ulcer, necrotic intestinal twisting, gallbladder inflammation, ruptured liver absctisment, pancreatitis, pelvic infection pathology (uterus, appendicitis), abdominal injury, abdominal wounds,…
2. Symptoms of acute peritonitis
Symptoms of acute peritonitis vary greatly depending on the cause of the disease. Common symptoms include:
- Constant abdominal pain, at first sheltered, after spreading
- Vomiting, hiccups
- Squash ate, sometimes diarrhea
- Abdominal wall rigid muscles, itoneal in touch
- Infection: high fever, rapid pulse, dirty tongue, dry lips, shallow rapid breathing, bad breath
- Neglect,, long-term anxiety, infatuated, deeply sunken eyes, gaping face, rapid pulse, hypothermia, oliguria or anuria.
The doctor will diagnose acute peritonitis based on physical examination and subclinical techniques.
- If the patient is young, strong, early, the doctor often sees spasms of the abdominal wall with manifestations such as: when pressing on the abdomen, it feels as hard as wood, the abdomen does not participate in breathing, the muscles are clearly straight. When typing it is possible to detect free vapor in the peritoneal cavity, hear a decrease in intestinal peredm, signs of Douglas bulging and pain. If the person arrives late in the month, there may no longer be spasms of the abdominal wall, the patient has symptoms of intestinal obstruction, abdominal resistance, total condition changes,…
- Clinical tests: leukocyukocycya, left leukocyty formula, Hematocrit increased due to dehydration, electrolycular disorders, increased blood ure,... X-rays can show specific signs of peritonitis such as water levels, vapor levels in intestinal obstruction, diaphragm vapor in perforation of the duodenal ulcer,…
Abdominal lumbar puncture is the most important test for the diagnosis of peritonitis. Laparoscopy and implantation to identify pathogenic bacteria.
3. Acute peritonitis surgery should be performed early
Acute peritonitis is a serious pathology, which if not treated in time the patient will be at high risk of death. With the main peritonitis, it is possible to treat the infection with antibiotics according to experience, after the results of antibiotics, it is treated according to antibiotics. The duration of treatment is 5-14 days depending on the patient's response.
For acute peritonitis, the principle of treatment is a combination of active resuscitation and surgical surgery. Medical treatment helps with resuscitation, energy supply, alleering infections, shock prevention and multi-agencyal failure. During surgical surgery helps to eliminate the cause and clean the infection socket.
3.1 Active resuscitation
Patients will receive infusions, electrolyses for rehydration, electrolyses. Adjust alkaline balance, ensure respiration, body temperature,… Antibiotics of a strong, broad spectrum, if antibiotics are available, antibiotics are used according to antibiotics.
3.2 Acute peritonitis surgery
Patients should undergo acute peritonitis surgery as soon as possible on the basis of active resuscitation. Resuscitation and surgery may be provided if the patient's condition is too urgent. The methods of intervention vary greatly depending on the cause of peritonitis. In each cause there are many treatments, the choice of which one depends on the condition of the abdominal sinuses and the patient's condition.
- In-abdominal circulation combination puncture method: is a commonly used combination diagnosis method of treatment today. The advantage of this method is gentle, less invasive, highly effective in some special cases. Often applied in cases of abdominal absss due to various causes such as appendix, an excess bag, ruptured liver absss,…
- Laparoscopic surgery: there are advantages such as less invasive, patients quickly recover, few complications, little scarring,… Laparoscopic surgery is in place in many cases such as: appendicitis, appendicitis, appendicitis, hollow organ perforation, bile arthritis, ruptured liver absculsion, abdominal wounds, trauma, necrotic intestinal torsion,…
- Abdominal open surgery: opening the abdomen to treat lesions still plays an important role in the treatment of peritonitis, but the in addition of this type of surgery is getting less and less due to the development of other less invasive techniques. Abdominal opening is in place to treat the lesion depending on the cause of the disease (patients with severe general peritonitis due to perforation of the organ, due to complications of the previous surgery or by the inaction by endoscopy,…) and the patient's condition (patients with contraincularity with laparoscopic surgery).
When performing acute peritonitis surgery, it is necessary to choose the appropriate entrance (skin incision or trocar site), which makes it easy to find the cause and easy to handle damage, clean the abdominal sinuses favorly and limit the risk of incision infection. Conduct an assessment of the lesion, treat the cause and clean the abdominal sinuses. Then liu and pick up the abdomen.
After surgery, the patient should continue post-surgical resuscitation medical treatment. Nutrition according to the disease and surgical methods. If the post-surgery condition stabilizes, encourage the patient to move early.
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