Main groups of diseases and organ damage abdominal cavity and rectum.
The concept of emergency abdominal surgery.
History of the development of emergency abdominal surgery.
Diagnostics urgent illnesses and damage to the abdominal organs and rectum.
Acute appendicitis.
Perforated stomach ulcer and damage to the stomach and intestines.
Acute intestinal obstruction.
Acute cholecystitis, liver and spleen damage.
Acute pancreatitis and damage to the pancreas.
Peritonitis.
Diseases and damage to the large intestine and rectum.
The role of knowledge about the main groups of diseases and injuries of the abdominal organs in the work of a nurse.
Considering the current volume of surgical interventions for diseases and injuries of the abdominal organs, the most important role of a nurse without the knowledge and professional skills of which this whole process would be practically impossible comes to the fore. Therefore, quality services in in this case directly depend on the professional knowledge and skills of the nurse.
1. The concept of emergency abdominal surgery.
Emergency abdominal surgery is one of the most difficult areas of surgery. Surgical intervention for acute diseases and injuries to the abdominal organs make up the majority of operations performed in district hospitals and clinics (more than 50%). The outcomes of surgical treatment largely depend on the timely hospitalization of patients, and therefore on the training of medical workers. These features are due to the severity of the patients’ condition, limited examination time due to the need for emergency surgery, as well as the complexity of diagnosis due to the fact that many diseases, to a greater or lesser extent, have symptomatology similar to acute surgical diseases of the abdominal organs.
Abdomen area - one of the most extensive and complex topographic-anatomical areas of the human body. The abundance of organs located in it and each having its own structural and functional characteristics, the presence of organocomplexes that are closely connected with each other and with the organs of neighboring areas, both anatomically and functionally. The complexity of the configurations of the cavities that make up the abdominal area - all this creates special conditions for the course of the pathological processes that arise here.
Their course is determined not only by the nature of the lesion and the specifics of the affected organ, but to a large extent by its topography, the characteristics of its fixation, blood supply, innervation, direction of lymphatic drainage pathways, that is, data surgical anatomy the organ, the part of the cavity in which it is enclosed, and the abdominal cavity as a whole.
Syndrome « acute abdomen » a collective concept, a symptom complex - characteristic of all diseases and injuries of the abdominal organs.
The most common diseases in clinical practice are inflammatory diseases. (acute appendicitis, acute cholecystitis, acute pancreatitis, etc.), destructive diseases of the abdominal organs (perforated gastric ulcer, duodenal ulcer, perforated appendicitis, ruptured ovarian cyst). No less often, a catastrophe in the abdominal cavity is caused by mechanical causes (strangulated hernia, cyst torsion, intestinal volvulus, intestinal obstruction due to obstruction, etc.).
2. History of the development of emergency abdominal surgery.
After the Great October Socialist Revolution, Russian emergency surgery rose to significant heights and acquired a certain authority in the world. In the Union republics, medical institutes, medical research institutes, and in some - institutes for advanced training of doctors were opened. Clinics and departments of medical institutes, institutes of emergency surgery, traumatology, etc. were opened. The network of beds in hospitals began to expand. Medical care was provided free of charge. To improve the treatment of tuberculosis patients, anti-tuberculosis departments, dispensaries, hospitals and sanatoriums were opened.
The network of beds for cancer patients gradually expanded.
Oncology departments appeared at medical institutes, research institutes, and oncology dispensaries.
A department of medical sciences was created at the USSR Academy of Sciences.
V. I. Razumovsky(1857-1935) - professor, surgeon, founder of the surgical school in Kazan. Rector of Saratov University (1909) with a single medical faculty. In 1912, the medical faculty of the university separated into an independent institute.
S. I. Spasokukotsky(1870-1943) - academician, professor at the II Moscow Medical Institute, one of the largest Soviet surgeons. He created a large school of surgeons (A. N. Bakulev, E. L. Berezov, V. I. Kazansky, etc.). Worked in Saratov. He published works on purulent surgery of the lungs and pleura, conducted clinical and experimental studies on waste blood transfusion, and proposed a method of washing hands before surgery.
N. N. Burdenko(1878-1946) - academician, professor of the faculty surgical clinic of the First Moscow Medical Institute. He created the Neurosurgical Institute in Moscow. 1st President of the Academy of Medical Sciences. The works of N. N. Burdenko on shock, wound treatment, neurosurgery, lung and stomach surgery left a big mark on a galaxy of descendants.
S. P. Fedorov(1869-1936) - a talented experimenter, the founder of Soviet urology, developed a number of issues in surgery of the thyroid gland and biliary tract.
A whole galaxy of surgeons: A. V. Martynov, A. V. Oppel, I. I. Grekov, Y. Dzhanelidze, A. V. Vishnevsky, V. A. Filatov, N. N. Petrov, P. A. Kupriyanov, A. A. Vishnevsky and many others created schools of surgeons, deepened the study of many branches of surgery, including emergency surgery of the abdominal organs, and successfully prepared surgeons of the USSR (12564) for the Great Patriotic War.
3. Diagnosis of emergency diseases and injuries of the abdominal cavity and rectum.
Surgical interventions for diseases and injuries of the abdominal cavity and rectum constitute the majority of operations performed not only in local and regional hospitals, but also in clinical hospitals.
The outcomes of surgical treatment of emergency surgical diseases and injuries of the abdominal cavity and rectum largely depend on the timely hospitalization of patients, and, therefore, on the training of medical workers at different levels.
Distinguish closed and open damage (injured) abdominal cavity. Among injuries to the abdominal organs, the greatest practical significance is damage to the liver, spleen, pancreas and hollow organs, i.e. stomach, small and large intestines.
Carefully collected medical history, this is of paramount importance for correct diagnosis and therefore timely and informed treatment. Despite the fact that there may not be much time to collect anamnesis, it is necessary to meticulously familiarize yourself with the basic anamnestic data, especially in the absence of indications for surgery.
In this case, it is necessary to pay special attention, first of all, to accurate data:
about the onset of the disease (morning, afternoon or night);
main symptoms (pain, vomiting, temperature);
course of the disease and therapeutic measures (administration of painkillers or other drugs carried out before hospitalization);
past illnesses (any operations on the abdominal organs);
allergy history (possible intolerance to any drugs);
state of organs and systems at the time of illness (chronic gastrointestinal diseases, full and empty stomach).
Main clinical manifestations :
pain (intensity, persistence, character, irradiation);
vomit is one of the common symptoms of acute abdominal diseases (frequency, nature of vomit, color and smell );
bowel function (retention of stool, gas, diarrhea, character of stool, frequency).
Objective examination.
Criteria for an objective examination of the patient :
appearance ( pained expression on his face sharpened features, sunken eyes);
color skin (pallor, cyanosis of lips, acrocyanosis, jaundice), cold sweat;
patient's behavior and posture (forced immobile position in bed, on your back or on side, as well as position« Vanki - stand up» ).
temperature in acute surgical diseases May be normal and even reduced (with perforation of gastroduodenal and typhoid ulcers, intra-abdominal bleeding, intestinal volvulus).High temperature (39-40º) occurs less frequently in (pneumococcal peritonitis, acute appendicitis in children). Most often, the temperature in acute inflammatory diseases of the abdominal cavity is in the range (38-38.5º WITH).
The cardiovascular system.
study of cardio-vascular system is of great importance in emergency abdominal surgery (first of all, it is necessary to excludemyocardial infarction which is accompanied by abdominal pain).
The character of the pulse is of great diagnostic importance:bradycardia (vagus pulse during perforations, volvulus in the first watch),tachycardia p ri ( peritonitis, acute bleeding);
discrepancy between pulse rate and temperature (usually isunfavorable sign indicating a severe catastrophe in the abdominal cavity).
Respiratory system.
for acute diseases of the abdominal organs (due to flatulence and elevation of the diaphragm), breathing disturbances are noted, which can lead to an error (pneumonia is diagnosed), which is often accompanied by pain in the abdominal area.
Abdominal examination.
Inspection.
upon examination belly - pay attention to him (form, participation in the act of breathing, bloating, vascular pattern).
Palpation.
palpation of the abdomen can determine a number of important symptoms, first of all(pain and its location) , so with typical localization of acute appendicitis, pain is noted(in the right iliac region, and in acute cholecystitis - in right hypochondrium, in acute pancreatitis - in the epigastric region and left hypochondrium).
sharp pain on superficial palpation(is a terrible symptom of acute abdominal disease);
sharp pain throughout the abdomencharacteristic (for perforation of ulcers, rupture of hollow organs and peritonitis);
sharp pain in the soft anterior abdominal wall indicates the presence of (blood in the abdominal cavity Kulenkampf's symptom);
leading symptom of acute abdominal disease is a symptom (Shchetkin-Blumberg);
upon palpation it is necessary to examine area of the liver, spleen and all departments gastrointestinal tract, it is necessary to determine(muscle tension), which is an objective symptom indicating irritation of the parietal peritoneum. In acute perforations, a so-called (board-shaped abdomen) is characteristic.
Percussion .
is a method to determine the presence (pneumoperitoneum, flatulence, effusion, bleeding, gastrointestinal contents during perforations and ruptures of hollow organs). Of great importance is the determination of liver dullness and the limitation of flatulence in the area strangulated intestine (Val's symptom).
Auscultation.
listened to intestinal peristalsis (lack of peristalsis, characteristic of intestinal paresis, increased or noted« splashing noise», Sklyarov's symptom for obstruction).
Finger examination.
study rectally rectum a must for all patients! admitted to the hospital for acute surgical diseases of the abdominal cavity.
examine the walls of the rectum(overhang, presence of infiltration, blood, mucus, pus).
prostate gland, bladder and pouch of Douglas. In case of acute intestinal obstruction (a gaping of the anus of the rectum is determined, a symptom of the Obukhov Hospital and bloody discharge in the form« jelly» with intussusception, volvulus sigmoid colon, thrombosis of mesenteric vessels, obstruction obstruction due to tumor).
Vaginal examination.
determine the size of the uterus(appendages, presence of fluid in the abdominal cavity).
Additional research methods.
laboratory (detailed blood test, biochemical analysis, blood for sugar, for group affiliation, blood for RW and hepatitis virus, general analysis urine, fecal occult blood test, dys/salmanellosis group).
R- logical methods:(overview), allows you to identify (free gas under diaphragm during perforation of a hollow organ), presence of fluid levels (at obstruction, Kloiber cups), presence of fluid in the abdominal cavity (at bleeding, tumors« ascites», purulent peritonitis).
contrast studies of the large intestine with the help of air and barium porridge for (iliocecal and colonic intussusceptions, strangulation of internal organs).
If acute surgical pathology of the abdominal organs is suspected immediately transport the patient to the hospital !! , while categorically It is forbidden to administer painkillers, give food or water, do a cleansing enema!! Introduction narcotic drugs only in case of shock (combined injuries). Cold on the stomach, peace.
4.Acute appendicitis.
The incidence according to data (Kolesova V.I., is up to 30% of all surgical interventions), a similar incidence is found in European countries and the USA.
Clinical picture depends on the location of the appendix in the abdominal cavity, the reactivity of the body, the stage of the disease and the presence of complications.
Location of the process may be (descending to the cecum 40-50%, lateral 25%, internal 17-20%, anterior 5-7%, and posterior retrocecal 9-13%)
Basic symptom pain in the right iliac fossa , epigastric or throughout the abdomen, starting suddenly. The pain is constant and gradually increases in intensity. General reaction of the body in acute appendicitis manifests itself malaise, fever, tachycardia and leukocytosis. The temperature reaction is usually moderate up to 38-38.5º, often subfebrile, especially in the elderly. In children it is more common hyperthermia (up to 39 º and higher). The pulse does not correspond to the temperature in severe destructive forms of o. Appendicitis, with the development of peritonitis. With simple phlegmonous appendicitis, the pulse usually corresponds to the temperature, increasing to 80-90 beats. in a minute. Leukocytosis in the initial stage of the disease can be moderate, with with a slight shift to the left and the appearance of C-reactive protein, the ESR accelerates. On examination, there is a lag in breathing in the lower abdomen; upon palpation in the right iliac region there is a muscle tension (muscular defense) , soreness, positive Shchetkin-Blumierg symptom. In addition, the following symptoms may occur: inguinal-scrotal (A.P. Krymova). Peritoneal-umbilical (D.N. Daumbadze). Increased pain on palpation of the right iliac region with the patient positioned on the left side (Bartomier-Mikhelson). Absence or decreased abdominal reflexes (N.N. Fomina), hyperesthesia of the skin in the right iliac region (I.Ya. Razdolsky). The appearance of pain in the right iliac region when quickly running the palm along the front surface of the abdomen from the costal edge down. Pain on palpation of the right iliac region intensifies when raising the straightened right leg (Obraztsov’s symptom). The appearance of pain in the right iliac region during rotational movements in the hip joint. Diagnosis of pelvic appendicitis in women is especially difficult; the participation of a gynecologist is necessary.
Acute appendicitis in children: develops at any age, but more often over 10 years (49.8%). Acute appendicitis usually occurs with pronounced general and local symptoms, with the rapid development of destructive changes, especially in children of the first years of life.
Treatment: Do not prescribe painkillers, hot water bottles, or laxatives.
The patient is taken to the hospital, the operation is appendectomy.
The nurse pays attention to: urination, flatus, pain, bandage, nutrition (1-2 days, tea, broth, jelly, kefir), for 3-4 days, boiled pureed food, pureed soups. For 7-8 days, regular food, avoid fatty and fried foods. Postoperative complications occur, most often only with destructive processes in the appendix.
Complications: formation of infiltrate; the appearance of ligature fistulas; suppuration of a postoperative wound; bleeding from the wound; bleeding into the abdominal cavity; formation of abscesses in the abdominal cavity; intestinal fistulas; the occurrence of intestinal obstruction; peritonitis.
5. Perforated stomach ulcer and damage to the stomach and intestines .
Complications peptic ulcer of the stomach and duodenum, more often occurs during an exacerbation, during stress, and alcohol intake. According to statistics, perforation of stomach ulcers is 32%, twelve duodenum 68% compared to acute appendicitis. Ulcer perforation is observed more often on the anterior wall of the stomach. As a result of perforation, peritonitis occurs, which is initially chemical (aseptic) and then bacterial in nature.
Diagnostics Perforated gastroduodenal ulcers do not present any great difficulties, except when the ulcer is localized on the posterior wall of the stomach.
Clinic: According to the clinical course it is necessary to highlight perforations , occurring acutely, with pronounced clinical symptoms and typical forms of perforated ulcers of the stomach and duodenum.
In case of acute perforation - pain occurs suddenly, radiates upward to the area of the shoulder girdle, collarbone, scapula due to irritation of the nerve endings of the phrenic nerve (phrenicus symptom of Elecker and Brkner).
Some patients may experience single vomiting of gastric contents, they are pale, their face is covered with cold sweat, cyanosis of the lips, and acrocyanosis are noted. The position is forced, often on the right side with the legs pulled up. The pulse in the first hours is rare (vagal pulse), breathing is rapid and shallow, the stomach does not take part in the act of breathing. The temperature at the beginning is normal or low-grade, with late admission up to 38%.
Objectively: the abdomen is somewhat retracted, and a transverse skin fold often appears above the navel. Tongue is wet, noted soreness, muscle tension in the anterior abdominal wall, (especially pronounced in the epigastric and right iliac region). Tapping on the right costal margin is painful. Shchetkin-Blumberg's symptom is sharply positive; upon percussion, the disappearance of hepatic dullness is noted (Jaubert's symptom)
When examining the rectum, tenderness is noted in the area of the pouch of Douglas (Kulenkampf's sign).
If a perforated ulcer is suspected, immediate hospitalization is required.
Differential diagnosis: carried out with acute cholecystitis, renal colic, acute appendicitis, acute pancreatitis, acute intestinal obstruction. Mortality: up to 6 hours 1-2%, up to 24 hours 30%.
Treatment : surgical – gastric resection or suturing of perforation.
Damage to the stomach and intestines .
Isolated injuries to the stomach and intestines are extremely rare.
On average they account for about 2% of all abdominal injuries.
More common are combined injuries to the stomach, liver, duodenum, pancreas and small intestine. Spontaneous gastric ruptures are dangerous, (especially if your stomach is full).
Closed injuries to the stomach can be severe and are accompanied by significant ruptures and even complete separation of the stomach.
Clinic: damage to the stomach depends on the severity of the injury, the condition of the patient, the presence or absence of a violation of the integrity of the organ.
With bruises without damage to the integrity, patients complain of pain in the epigastric region, resistance of the muscles of the anterior abdominal wall, and there are no symptoms of peritoneal irritation.
In case of damage that disrupts the integrity of the stomach, a severe course of the disease is noted. Patients complain of severe abdominal pain. The condition is serious, there are severe symptoms of shock. On palpation, tension in the muscles of the anterior abdominal wall, symptoms of pneumoperitoneum, irritation of the peritoneum and rapidly increasing peritonitis are noted.
Treatment: surgically, the ruptures are sutured or the duodenum is sutured end to end, or a gastroenteroanastomosis is applied. The operation ends with drainage of the abdominal cavity. Mortality up to 15-20%.
6.Acute intestinal obstruction .
Acute intestinal obstruction is one of the most severe acute surgical diseases of the abdominal cavity and accounts for 2-3% of all surgical diseases. According to the mechanism of occurrence, it is divided into:
Dynamic (4-8%); spastic (1-2%); paralytic (4-6%); mechanical (0.5-1%), strangulation (0.2-0.5%), obturacin (0.7-0.8%). Combined forms of acute intestinal obstruction include intussusception and individual forms of adhesive intestinal obstruction.
Diagnosis of various forms of acute intestinal obstruction presents certain difficulties due to the similarity of symptoms with acute surgical diseases of the abdominal cavity of other etiologies.
Main symptoms of the disease: patients complain of severe cramping pain in the abdominal cavity, repeated vomiting of gastric contents, retention of stool and gases, the state of health of patients during non-attack remains satisfactory. The tongue is moist, the abdomen is slightly swollen, soft, painless, the symptom (S-B) is negative. With palpation, it is sometimes possible to palpate an area of spasmodic intestine . Clinical symptoms vary (certain symptoms predominate) depending on the form and stage of development pathological process.
Treatment patients can undergo either surgical or conservative treatment.
7. Acute cholecystitis, damage to the liver and spleen .
Inflammation of the gallbladder wall with disruption of its function. According to the severity of changes in the wall, they distinguish between catarrhal, phlegmonous, gangrenous and perforated.
Clinic: onset is acute, with attacks of pain in the right hypochondrium. The pains are intense, constant character . Repeated vomiting does not bring relief, there is an increase in temperature to 38º, tachycardia. Skin with an icteric tint (ecteric sclera). The tongue is dry with a whitish coating. On palpation of the abdomen: noted tension in the muscles of the anterior abdominal wall in the area of the right hypochondrium (an increased gallbladder), positive symptom (Sh-B), perforation is characterized by symptoms of peritonitis.
Liver damage.
They belong to the group of very severe injuries to the abdominal organs. There are open and closed damage liver.
Closed According to various authors, damage occurs in 59% of cases. Damage occurs due to liver trauma, compression and severe concussions. (anti-impact, fall from height, abdominal bruises). With pathologically altered liver (malaria, syphilis, cirrhosis, etc.), Damage may also occur due to minor trauma or increased intra-abdominal pressure, for example when lifting heavy objects, etc. Liver damage is distinguished: a) without violating the integrity of the capsule (subcapsular and central hematomas) and b) with violation of the integrity of the capsule
Clinic. Depends on the severity of the injury, the nature of the injury and the condition of the patient. If part of the capsule is preserved, patients complain of pain in the liver, pain in the right hypochondrium, muscle tension (defans), and jaundice of the skin is often noted (extericity ), general weakness, tachycardia. With extensive hematomas and liver damage, the condition of patients is severe due to severe intoxication, impaired liver function and shock.
If the capsule is damaged, the patient's condition is very serious, with symptoms of shock, intra-abdominal bleeding and peritonitis. When examining, you should pay attention to abrasions and bruises, which are most often located in the lower parts of the right half chest and right hypochondrium. The abdomen is somewhat swollen, does not participate in the act of breathing, the Shchetin-Blumberg symptom is positive. During percussion, there is a dullness of the percussion sound in sloping places.
Treatment. Wounds and closed injuries are subject to urgent surgical intervention. During the operation, an oblique incision is used in the right hypochondrium according to Fedorov-Kocher. Resection of the liver lobe is performed extremely rarely, only with complete destruction of the left lobe. The hematoma is emptied by incision. The operation ends with drainage of the abdominal cavity. The postoperative period can be complicated by shock, bile peritonitis, hepatorenal syndrome, secondary bleeding, liver abscesses, subphrenic abscess, bile fistulas, and sepsis.
Modern medicine has an incredibly huge arsenal of therapeutic, physiotherapeutic, surgical methods for salvation human life. Some of them never leave consequences, while others lead to some changes in the body in almost one hundred percent of cases. Any intervention in the human body, unfortunately, has its consequences, and any infection, injury or surgical operation on the abdominal organs is a serious intervention. This is why we so often have to deal with such a disease as adhesive disease in the abdominal cavity.
A number of scientists believe that any surgery of the abdominal organs leads to the formation of adhesions, but, fortunately, most of of these dissolve over time and therefore the patient does not feel discomfort. Other patients, due to the specific structure of their organs and tissues, are less fortunate, and even a minor surgical procedure or injury can lead to very serious consequences.
It is well known that almost all organs of the abdominal cavity are covered with a delicate translucent membrane called the peritoneum. It has two layers - visceral and parietal, passing into each other. Peritoneum plays important role in maintaining body homeostasis, correcting water-salt metabolism. In addition, it also performs a protective function.
When any organ of the abdominal cavity is damaged, the peritoneum is immediately involved in the body’s reaction. In an attempt to fence off the affected area, the peritoneum adheres to the area of inflammation, injury, or the site of the surgical wound. In most cases, upon recovery, the peritoneum “falls back into place.” But sometimes, with chronic inflammation, whitish films are formed from the peritoneum to the organ - fibrous strands, which over time become denser and grow with connective tissue. This is how adhesive disease manifests itself.
Later, the tissue becomes even denser, it can even ossify and become saturated with calcium salts, and choroid plexuses and nerve bundles can grow into its thickness. Adhesions surround the internal organs like a web, displace them, and sometimes form constrictions.
The reasons for the formation of adhesions are very different. These are mechanical damage - blows, stab wounds, falls from a height, surgical operations and manipulation. Often, adhesions occur after severe chemical injuries, such as burns with acids and alkalis, when bile is leaked due to a ruptured gallbladder, or gastric contents due to injury or a perforated gastric ulcer. Among inflammatory diseases of the abdominal cavity, acute appendicitis, peritonitis, cholecystitis, and enteritis of various etiologies can lead to the appearance of adhesions.
Symptoms of adhesive disease in the abdominal cavity
Most often, the intestines are affected. Adhesions get tangled between intestinal loops, compress nerves and blood vessels, impairing blood supply to the compressed area. The body fights the disease by increasing peristalsis. Pressing transient pain, nausea, vomiting, and constipation appear. Feces lingering in the intestines begin to ferment, which causes increased formation of gases. The intestinal loops stretch more and more, which causes additional pain.
If the process affects the colon, the disease begins with constipation. If it’s thin – with pain, nausea and vomiting. Vomiting with adhesions small intestine painful, not bringing relief. Nausea and pain are constantly increasing. Similar symptoms may disappear and recur quite often. Compression of the intestine by adhesions can lead to necrotic processes in the intestinal wall and then emergency surgery will be required to save the patient’s life.
Adhesive disease is very diverse in its symptoms and usually manifests itself gradually, progressively increasing. Sometimes, the disease can attract attention many years after the operation, and in some cases it may even turn out to be an accidental discovery.
Diagnosis of adhesive disease in the abdominal cavity
Making a diagnosis of “adhesive disease” can be quite difficult. First you need to remember whether the patient has suffered Lately any injuries, operations, inflammatory diseases of the abdominal organs. After collecting complaints and medical history, the patient is sent for a contrast X-ray examination. If adhesive process has gone far and intestinal obstruction has formed, radiography will show us the presence of specific formations - Kloiber's cups.
Kloiber bowls
Modern diagnostic methods, such as ultrasound of the abdominal organs, magnetic resonance imaging, electrogastroenterography, greatly facilitate the detection of of this disease. They allow you to visualize the position internal organs and the influence of the adhesive process on them.
If the above methods are not very informative, laparoscopic examination is used. The essence of the method is to insert miniature video cameras and manipulators into the abdominal cavity through small incisions in the anterior abdominal wall. Manipulators allow you to look behind various organs and reach the most difficult to reach calving abdominal areas. The laparoscopy method allows you to immediately move from routine observation to surgical treatment adhesive disease.
Treatment
In essence, laparoscopy is the same operation, only much less traumatic.
Treatment of adhesive disease in the abdominal cavity is divided into conservative, surgical and preventive. Conservative treatment is prescribed for mild chronic course a disease that gives only periodic painful attacks and constipation without serious intestinal obstruction. In such cases, the patient is prescribed special diet
, aimed at moderately enhancing peristalsis and reducing gas formation. The use of fractional nutrition is effective - eating in small portions at short intervals. You should eat at the same time, following a daily diet. It is necessary to exclude foods such as carbonated drinks, grapes, cabbage, legumes, milk and its derivatives,. spicy dishes Fasting during adhesive disease is strictly contraindicated! With frequent and long-term constipation
laxatives are used. It is entirely justified to take probiotics and enzyme preparations that improve digestion processes. Except special diets , adhesive disease is treated with physiotherapeutic methods of treatment: electrophoresis with enzymes that dissolve adhesions, paraffin, mud,. For mild damage to internal organs, special courses are effective. physical therapy, allowing you to “stretch” fibrous cords. In consultation with the attending physician, herbal medicine may be performed.
Surgical treatment is used if ineffective conservative therapy with long-term persistence of pain and stool disturbances, as well as in emergency situations in case of intestinal obstruction.
If the intestine is passable, laparoscopic surgery is performed. Using miniature video cameras and special manipulators, the affected organs are removed and adhesions are cut. In such situations, laser therapy methods can also be used - dissection of adhesions with a laser beam, aquadissection - the use of a water jet under high pressure, electrosurgery - excision of fibrous constrictions with an electric knife.
In case of intestinal obstruction, laparotomy is possible - a “classical” surgical approach, in which not only excision of adhesions is performed, but also resection of the necrotic area of the pinched intestine. In addition, the intestinal loops are fixed in a functionally advantageous position, so that in the event of re-formation of intestinal specks, they avoid infringing on the area of the intestinal loop.
Preventive treatment consists of preventing the disease from occurring in people at risk of developing it or minimizing its consequences as much as possible.
To reduce the risk of adhesive disease in abdominal surgery, fibrinolytics are actively used - drugs that destroy fibrin - the main component of fibrous adhesive cords, anticoagulants - which do not allow blood clots to form, proteolytic enzymes - drugs that dissolve adhesive tissue, as well as various anti-inflammatory drugs and antibiotics .
Conclusion
In a broad group of diseases of the abdominal organs, there is a group of acute surgical diseases, united under the name “acute abdomen”. It includes acute appendicitis, acute cholecystitis, acute pancreatitis, intestinal obstruction, strangulated hernias, perforated gastric and duodenal ulcers and gastrointestinal bleeding.
Diseases are distinguished both by clinical picture and etiopathogenesis. They have one thing in common - they all pose an immediate threat to life if not treated in a timely manner. Most of these diseases require emergency surgery. The result of treatment of diseases included in the “acute abdomen” group depends on the time elapsed from the onset of the disease to the operation. Closely related to these diseases are injuries to the abdominal organs, which are also fraught with the development of peritonitis and internal bleeding.
All patients with acute surgical diseases of the abdominal organs are subject to immediate hospitalization in surgery department. It is impossible to predict the course of any disease included in the “acute abdomen” group. The results of treatment also depend on the time of hospitalization. The earlier the operation was performed for inflammatory process in the abdomen, the less chance of developing such a serious complication as peritonitis. The sooner measures are taken to stop bleeding from a stomach ulcer, the greater the chance of saving the life and health of the patient.
Early hospitalization in a FAP depends on the early appeal of patients and the accuracy of diagnosis. As a rule, patients with a perforated stomach ulcer are the most likely to turn to a paramedic. strangulated hernia, acute cholecystitis, i.e. in diseases with severe pain. When the clinical picture is blurred, when general health does not suffer, patients come late.
The role is especially great FAP paramedic when deciding whether to hospitalize a patient. Sometimes the initial examination does not allow us to determine accurate diagnosis, and the erased course of the disease leaves me writing in doubt. More often this happens in cases where the sudden pain was not severe and quickly passed. In the absence of pain as an alarm signal, it can be difficult to convince a patient to go to a central district hospital, located several tens of kilometers away, just to be examined by a surgeon. The accuracy of diagnosing diseases of the abdominal organs largely depends on correct technique examination of the patient.
Methodology for examining patients with diseases of the abdominal organs
An objective examination of the patient should be carried out in a warm, dry room with good lighting. When clarifying complaints and life history, you need to ask whether the patient has suffered from any chronic diseases abdominal organs, infectious diseases, diseases of the cardiovascular system, whether there have been any operations, and, of course, whether there have been hernias of the abdominal wall.
If you follow a certain order during the interview, you can collect a good and complete history; this does not take much time, but helps to quickly establish the correct diagnosis. But you cannot rely only on anamnesis data. Always need to do full examination sick.
The examination begins with a statement of facial expression, skin color and lips. In some acute diseases of the abdominal organs, for example, in advanced peritonitis, acute obstruction intestines, the face takes on a specific expression called the face of Hippocrates. A suffering facial expression, pointed features, sunken eyes, dark pigmentation of the skin of the eyelids - all this indicates severe symptoms of intoxication (peritonitis, acute intestinal obstruction). Severe pallor, cold sweat, and dull eyes may indicate internal bleeding from an ulcer. Different shades of icteric staining of the sclera, skin, mucous membranes indicate an increase in bilirubin in the blood, liver dysfunction (cancer of the papilla of Vater, calculous cholecystitis, cholecystopancreatitis, etc.). Cyanotic spots on the limbs, abdomen, low temperature on the extremities they often occur during the terminal phase of pancreatic necrosis.
It is equally important to pay attention to the position the patient chooses. Usually the patient strives to take a position in which he would be most comfortable - he would be least bothered by pain. In case of damage to the liver, spleen with internal bleeding patients are pale, apathetic, lying on the side of the damaged organ (the “vanka-stand up” symptom). A restless, frequently changing position due to abdominal pain indicates inflammation or perforation of hollow organs. Be sure to measure arterial pressure. In this case, it is necessary to clarify what the patient’s usual, “working” pressure is. The pulse is counted for a minute. For more a short time You may not catch rhythm disturbances, sudden extrasystoles, etc. Special attention pay attention to the pulse rate. The correspondence of pulse rate to body temperature has great diagnostic value. Normally, for every 10 °C increase in body temperature, the pulse increases by 8-10 beats per minute. The discrepancy between pulse rate (exceeding it) and body temperature is an important symptom serious violations in organism.
Measuring body temperature, in addition to the armpit, should also be performed in the rectum, where normally the temperature is 0.5-0.7 °C higher than in armpit. During acute inflammatory processes in the pelvic cavity, near the rectum, the temperature in its lumen becomes 1-2 °C higher than in the armpit.
You should pay attention to the breathing frequency (the norm is 16-20 respiratory movements). Significant shortness of breath, i.e. more than 25 respiratory movements per minute with normal temperature body is a serious symptom of general ill-being.
They examine the tongue, which ancient doctors called the “mirror” of the abdomen. A dry, brown-coated tongue is a symptom of intoxication and dehydration of the body.
When examining the abdomen, pay attention to postoperative scars, be sure to specify what and when the operation was performed. If there is a certificate from medical institution, then you should definitely look at it and take it with you during hospitalization. Great importance for diagnosis has the shape of the abdomen: swollen, not swollen, evenly larger or larger in any part; on the contrary, the so-called “frog belly” is retracted. Abdominal asymmetry is often observed with acute intestinal obstruction, tumors, etc. With accumulation in the abdomen large quantities liquid, the abdomen is evenly increased in size and seems to be spread out, its lateral sections seem to “hang down”. Be sure to examine the places where hernias may occur - the inguinal and femoral areas, the area of the umbilical ring. Attention is drawn to areas of the anterior abdominal wall while breathing; this symptom is very important, since with peritonitis the abdominal wall is motionless or its movements are extremely limited. To clarify this, you need to ask the patient to first inflate his stomach as much as possible, and then retract it. Patients with peritonitis, as a rule, cannot do this due to severe pain. If there is an acute inflammatory process in the abdominal cavity, movements of the anterior abdominal wall are accompanied by the occurrence of pain at some localized point, and the patient can quite accurately indicate with his finger the place of greatest pain. The location of independent pain is specified, for which the patient is asked to show the place of greatest pain with one finger.
Then the patient is asked to cough, and pain appears or intensifies at the site of the pathological process. Another similar method - the patient is asked to strongly inflate or retract his stomach - the pain, as a rule, intensifies in the area of the pathological focus.
Palpation of the abdomen begins far from the location of the pain. Superficial palpation reveals an area of maximum pain and tension in the muscles of the anterior abdominal wall. A continuation of superficial palpation is deep palpation abdomen, the purpose of which, in addition to clarifying the area of pain, is to identify pathological formations in the abdominal cavity and palpation of individual organs.
The liver can be felt in the right hypochondrium. Normally, its edge is smooth, soft, painless and may slightly protrude from under the costal arch. In the right iliac region, the dome of the cecum is palpated in the form of a doughy roll, sometimes rumbling upon palpation. In the left iliac region, the sigmoid colon is palpated, also painless. The spleen is not normally detectable; Only with a significant enlargement of the spleen, which often happens with the development of portal hypertension, does it become accessible to palpation.
Percussion of the abdomen determines the boundaries and presence of hepatic dullness. If you receive a box sound in the right hypochondrium, i.e., the absence of hepatic dullness, you can think about the presence of free gas in the abdominal cavity and suspect perforation of a hollow organ. Percussion determines the presence of fluid in sloping areas of the abdomen. To do this, percussion is performed first while lying on the back and the border of dullness of the percussion sound is marked, then the patient is turned to the side and percussed again where there was dullness. If there is fluid in the abdomen, it flows down and the dullness disappears.
After palpation and percussion, they proceed to auscultation of the abdomen and determine a number of symptoms that occur in many acute surgical diseases of the abdominal organs. The abdomen is auscultated using a phonendoscope, or, if it is not available, with the ear.
Normally, irregular bowel sounds of varying intensity are heard. The complete absence of peristaltic noise - “deathly silence” - along with other symptoms is an important sign of an inflammatory process in the abdominal cavity.
The examination of the patient is completed with a rectal and vaginal examination.
Differential diagnosis of diseases with “acute abdomen” syndrome
The abdominal form of myocardial infarction is accompanied by severe pain in the abdomen and tension in its anterior wall. In this case, the pain in the epigastrium intensifies in waves, lasts for several hours and passes. With myocardial infarction, in addition to abdominal pain, pain in the chest, neck, arm, loss of strength, perspiration, characteristic changes ECG, creatinine phosphokinase and transaminase indicators over time. In the first hours of perforation of a stomach ulcer, muffled heart sounds are often observed with bradycardia and severe pain in the epigastric region. Increased dullness of heart sounds and increased heart rate over 100 beats per minute, dry tongue, thirst, tension in the anterior abdominal wall, deterioration of general condition, leukocytosis are typical for peritonitis.
Sometimes pneumonia and pleurisy can occur with the “acute abdomen” syndrome. With pneumonia, abdominal pain is observed at the onset of the disease, it affects only the right or left half of the stomach, and muscle protection is inconsistent. The onset of pneumonia and fever is taken into account, peristaltic pumas in the abdomen are listened to every 5 s; the patient moves freely in bed. Timely recognition pulmonary pathology with accompanying mild abdominal symptoms contributes to the correct orientation of the paramedic or doctor.
Abdominal bloating, its asymmetry, projection of peristaltic contractions of intestinal loops onto the surface of peristaltic contractions of intestinal loops visible to the eye are inherent in its mechanical obstruction.
Restricted mobility of the anterior wall, accompanied by pain, indicates an inflammatory process in the correspondingly located organ. Thus, pain in the right hypochondrium often indicates acute cholecystitis, and in the right iliac region - acute appendicitis. Severe pain in the epigastrium, left hypochondrium and absence of aortic pulsation are a sign of acute pancreatitis. Sharp pain on superficial palpation indicates perforation of a hollow organ with the development of peritonitis. The sensation of sharp pain when pressing on the abdomen or quickly removing the hand indicates inflammation of the parietal peritoneum (Shchetkin-Blumberg syndrome). By palpation, one can identify neoplasms emanating from internal organs (liver, spleen, intestines, uterine appendages, from the retroperitoneal space, etc.). At paralytic obstruction bowel sounds are sharply weakened, complete absence they are pathognomonic for diffuse peritonitis. If an acute abdomen is suspected, a digital examination of the rectum is mandatory. When the sigmoid colon is torsioned, the rectal sphincter gapes. Digital examination of the rectum allows you to identify a tumor in it, palpate the prostate and back wall Bladder, identify fluid or blood fluctuations, pain due to peritonitis.
Abdominal pain in women dictates the need for a vaginal examination, since they are often caused by diseases of the genital area. In the case of inflammatory processes of the appendages, pain is felt when moving the uterus. Tarry-like bleeding when menstruation is delayed by 1.5-2 months may indicate an ectopic pregnancy, purulent discharge - inflammation of the appendages, greenish-yellow color - gonorrhea. To clarify the diagnosis, it is necessary to do a culture or take a smear to determine the microflora. In doubtful cases, if an ectopic pregnancy or ovarian apoplexy is suspected, it is advisable to perform a puncture of the posterior fornix.
Data laboratory research play a certain role in the diagnosis of acute diseases of the abdominal organs. An increase in the number of leukocytes, a shift in the leukocyte formula to the left, especially the appearance of young forms of leukocytes, increased ESR suggest a pronounced inflammatory reaction. Biochemical blood tests (bilirubin, amylase, sugar and residual nitrogen) may indicate damage to a specific abdominal organ. A urine test can confirm or rule out kidney disease.
Diseases of the abdominal organs are very often dangerous and require immediate surgical intervention. The symptoms of such diseases are also very extensive and overlap with the symptoms of pneumonia or myocardial infarction, but such acute conditions do not require immediate surgical intervention.
general characteristics
Acute inflammatory diseases of the abdominal organs are a whole clinical symptom complex that occurs against the background of diseases or damage to internal organs. Most often, the disease can be eliminated solely through surgery.
The first examination is usually carried out at home or in an outpatient department. The later the patient seeks help, the worse the prognosis for recovery.
General symptoms and medical history
To make a correct diagnosis, the doctor requires a thorough history taking. Almost all injuries and diseases of the abdominal organs are accompanied in the abdominal area. But this subjective symptom, which requires clarification. Perhaps it all started after eating or a blow to the peritoneum; the cause could be alcohol or a fall.
Along with the main symptom, pain may be accompanied by cutting and stabbing sensations. Some patients experience pain radiating to the scapula, groin, lower back, or scrotum area. The doctor will also clarify the frequency of pain and how long it has been bothering the patient. Perhaps it is a girdle or chest pain.
Together with painful sensations, the patient may experience nausea and vomiting. If there is vomiting, it is very important what kind of vomiting it is, debilitating or indomitable, and how many times it happened. What does vomit consist of: food that was recently consumed or mucus. If it is mucus, what color is it, what is its smell?
The opposite symptom of vomiting may be constipation or bloating. In this case, it is very important whether the patient suffers from constipation, and when defecation occurs, there is blood content in it. What symptoms are accompanied by defecation? Perhaps the patient has pain in the abdomen, is there rumbling and gases?
For staging correct diagnosis It is also very important whether abdominal pain is accompanied by an increase in body temperature. How are things going with urination, is there any delay, is there an increase or decrease in the amount of urine.
The doctor must definitely check with the patient whether any methods of eliminating abdominal pain have been previously used, either prescribed by medical professionals or chosen independently, for example, enemas or applying a heating pad.
Possible reasons
Diseases of the abdominal organs can appear in a number of cases:
- If there was damage (impact) to the abdominal area.
- Acute inflammatory processes, including peritonitis.
- Mechanical damage, as a result of which obstruction develops.
- Perforation of the genital organs.
- Disturbances in the functioning of the venous and arterial circulation. Such problems can cause the development of intestinal infarction, in some cases even gangrene begins against the background of intestinal obstruction.
- Bleeding in the peritoneum or gastrointestinal tract.
- Inflammatory processes in the female genital organs ( ectopic pregnancy, torsion of the cyst legs, necrosis, tumors and others).
Acute intestinal obstruction
This type pathology occurs against the background of disturbances in the process of movement of intestinal contents. Obstruction may be partial or complete.
Dynamic or functional obstruction is also distinguished, in which there may be spastic obstruction resulting from poisoning (chemical or drugs). A provocateur in such a situation can be foreign body, adhesions in the intestines. The paralytic type of pathology may be a consequence of urolithiasis or cholelithiasis. Diagnosis of diseases of the abdominal organs in this case can be somewhat difficult, as it is accompanied by multiple symptoms that can be confused with other diseases.
Mechanical obstruction occurs against the background external factors: external pressure, due to narrowing of the lumen in the intestine, during the formation of nodes or volvulus.
Symptoms of disease of the abdominal organs with intestinal obstruction may be as follows:
- pain in the abdominal area of varying intensity and character;
- bloating due to constipation;
- nausea and vomiting, with offensive discharge.
In such cases, the patient's condition quickly deteriorates, facial features become sharpened, and there may be strong and bad smell. The pulse is uneven, the pressure may drop.
Emergency assistance in this case is as follows:
- the patient should be put to bed;
- the patient should not be allowed to drink or eat, only rinsing the mouth is permissible;
- administration of “Polyglucin” and glucose is allowed;
- you can administer a 2% solution of “No-shpa” or a 1% solution of “Diphenhydramine”.
Immediately call an ambulance for further hospitalization.
Acute appendicitis
Given inflammatory disease abdominal organs are subject to immediate surgical intervention. Pain sensations depend entirely on where the appendage of the cecum is located. Also, the symptoms depend on whether appendicitis is simple or purulent, diffuse.
The most characteristic signs: acute and sharp pains in the abdominal area, usually manifested by attacks. Pain begins in the area on the right side of the lower abdomen, then may appear in the stomach and navel, then moves to the area on the right. At the initial stage, nausea may occur. If the intestinal extension is located in the pelvic area, the patient may have diarrhea. Body temperature may rise up to 40 degrees. When palpating the abdomen, the pain intensifies in the lower right region.
Until the ambulance arrives, the patient should be kept at rest and not allowed to eat or drink. You can apply an ice pack to the right abdominal area. If the patient has not been taken to the hospital within 6 hours, then he can be given Gentamicin and Ampicillin. Severe pain can be relieved with an injection with Analgin. Under no circumstances should you use laxatives or a heating pad.
Perforated ulcer
This disease is characterized by sudden pain and this applies equally to duodenal ulcers and gastric ulcers. Vomiting very rarely appears, and if present, it appears immediately after the next attack. A person cannot be sitting or standing, he needs to lie down, at this time the stomach is more like wood, very hard and does not participate in the breathing process. Clinical picture perforated ulcer very similar to acute appendicitis.
Treatment of diseases of the abdominal organs in this type of pathology involves compliance with bed rest, refusal of water and drinking.
Before doctors arrive or the patient is taken to a medical facility, under no circumstances should you warm the abdomen, rinse the stomach, give an enema, or give laxatives. You can only introduce a painkiller, for example, Tramal and antibacterial agent- “Gentamicin” or “Ampicillin”.
Pinched hernia
The development of this type of disease of the abdominal organs is possible after reduction of the hernia, or if there were previously problems with this formation. At the moment of pinching, the patient experiences vomiting, which after some time consists not only of food, but also of bile. Appear In advanced cases, the skin in the area of the hernia may turn red, the organ itself may bulge, body temperature may rise, and pain may radiate to the leg.
In this situation, the patient is also indicated for bed rest. If there is no medical institution, then you can try to repair the hernia yourself. First, the patient should be given an anesthetic, preferably No-shpu or Atropine. Be sure to let the person go to the toilet. Then the patient lies on his back, slightly raises and bends his legs, and places a pillow under his buttocks. After 20 minutes, you can begin to slowly reduce the hernia using soft and leisurely movements. After the procedure, the patient should not break bed rest for at least a day.
Acute mesenteric thrombosis
The pathology is characterized acute disorder in the functioning of the circulatory system in the mesenteric vessels. It can appear against the background of thrombosis or embolism, and is typical for middle-aged and elderly people.
Depending on the level of vascular damage, there are also sharp pains, which may bother you in the area of the right iliac region, if the main trunk is damaged. If the inferior mesenteric artery is affected, then pain is observed in the left iliac region. In terms of symptoms, thrombosis is very similar to intestinal obstruction and acute appendicitis. The patient may experience tachycardia, nausea with vomiting, bloating, and delayed bowel movements.
Thrombosis of this type classified as surgical diseases of the abdominal organs, since it really poses a threat to human life. The mortality rate for this pathology ranges from 70% to 90%.
Gastrointestinal bleeding
The clinical picture of this acute condition consists of the sudden onset of bleeding. TO associated symptoms may include: dizziness, loss of strength and low blood pressure, severe vomiting with blood clots. Feces become tarry in color and appear around the patient's eyes. yellow circles, there is an increase in heart rate,
Bleeding often occurs due to complications of a stomach or duodenal ulcer. If we are talking about light bleeding, characterized by chronic form, then a person may develop anemia.
Heavy bleeding is an acute surgical disease of the abdominal organs and requires immediate surgical intervention.
Peritonitis
As a rule, peritonitis occurs against the background of an ulcer, cholecystitis or injury. Characterized by an inflammatory process in the peritoneum. The inflammatory process can affect only a small area of the peritoneum, or it can be diffuse, or involve the entire area in the process.
The acute form of this disease of the abdominal organs is characterized by increasing pain that increases with movement. A person cannot walk or sit; he needs to lie down. Everything in the mouth is dry, the patient is thirsty, and the tongue is covered with a whitish coating. After some time, vomiting begins, releasing brown and foul-smelling liquid. The temperature can rise above 39 degrees.
On palpation, an increase in the volume of the abdomen is observed, the wall of the peritoneum is very hard and hurts from the slightest touch. If you listen to peristalsis, you can clearly hear the sounds. When sounds in this area subside and the patient’s hiccups disappear, this indicates that he is in an extremely serious condition.
In addition to bed rest, before arriving at the hospital, the patient can be given Gentamicin and Tramal to relieve severe pain.
Damage to abdominal organs
With penetrating wounds, surgical disease of the abdominal cavity almost always occurs. If the spleen or liver is damaged, intra-abdominal bleeding is usually observed. A wounded person experiences decreased blood pressure and diffuse pain throughout the abdomen. If hollow organs, intestines or stomach are damaged, symptoms characteristic of inflammation of the peritoneum are observed.
If we are talking about a minor injury, then it can be used conservative treatment, with more severe cases without surgical treatment not enough.
Acute cholecystitis
This is a disease in which the gallbladder becomes inflamed. It all starts with sudden pain in the right hypochondrium. The most common cause of exacerbation of the inflammatory process is cholelithiasis (90% of cases).
After diagnosing a surgical disease of the abdominal organs, treatment tactics are determined. It is possible that the operation will not even be performed immediately after hospitalization; everything completely depends on the physical condition of the patient. In the first 8-12 hours, metabolic processes can be corrected.
With absence medical education and the ability to transport the patient to the hospital, the administration of painkillers and other medicines which may adversely affect human health.
Pathogenesis: Peritoneal infections usually occur when normal anatomical barriers are disrupted. Normally, the peritoneal space is sterile. Peritonitis can be primary (without a visible damaging factor) or secondary. In adults, primary or spontaneous bacterial peritonitis is more common among patients with alcoholic cirrhosis of the liver and almost always develops with ascites. Pathogenesis is associated with ascites, when the liver, due to impaired portal circulation, is unable to perform the filtration function. The infection is usually caused by a monoflora with accompanying bacteremia.
Secondary peritonitis develops when bacteria infect the abdominal cavity as a result of their entry from an intra-abdominal lesion. At secondary peritonitis usually there is a mixed aerobic and anaerobic microflora.
Clinical manifestations: Fever is observed in 80% of patients with primary peritonitis. Stomach ache, acute development symptoms and symptoms of abdominal cavity lesions during physical examination are diagnostically significant, however, the absence of these signs does not exclude the diagnosis. Ascites usually precedes infection.
Secondary peritonitis. Local symptoms depend on the provoking factor. When a gastric ulcer perforates, pain appears in the epigastrium. For appendicitis initial symptoms vague and include nausea, a feeling of discomfort in the peri-umbilical region, gradually moving to the right lower quadrant. Symptoms of secondary peritonitis include abdominal pain, aggravated by movement, coughing, and sneezing. The patient usually pulls his knees toward his abdomen to relieve tension on the peritoneal nerves. When examining the abdominal cavity, voluntary and involuntary tension of the abdominal wall is determined, late stages– radiating pain.
Diagnostics: To diagnose primary peritonitis, the abdominal cavity is punctured in every febrile patient with cirrhosis. Peritoneal fluid is collected in a sterile container with a nutrient medium to improve the effectiveness of its cultural examination. The blood is also tested for sterility. If secondary peritonitis is suspected, diagnosis is aimed at finding a provoking factor; The abdominal cavity is punctured to obtain fluid rarely.
Treatment: In case of primary peritonitis, it is aimed at the recovery of the patient. Includes suppression of gram-negative aerobes and gram-positive cocci. If a patient with suspected peritonitis is cultured mixed microflora(in particular, anaerobes), secondary peritonitis should be excluded. Treatment for secondary peritonitis includes antibiotics directed against aerobes, gram-negative microbes and anaerobes, along with surgical intervention, eliminating the cause.
Abdominal abscesses
Pathogenesis: Abdominal abscesses reflect both the disease and the body's response to it. Anaerobes are the most significant in the development of abscesses, in particular Bacteroides fragilis. A whole group of virulence factors B. fragilis plays a role, in particular, in the capsule polysaccharide complex, lipopolysaccharide, and superoxide dismutase, which increases the viability of bacteria. Some immune factors, in particular T cells, are also involved in the formation of abscesses.
Clinical manifestations:
Loosely located peritoneal abscesses. They can be located intra- and retroperitoneally and in 74% of cases are not associated with a specific organ. The most common sources are infection from the female genitalia and pancreas. Fever is the most characteristic symptom. As with secondary peritonitis local symptoms depend on the provoking factor. For abscess m. psoas is typical of back or abdominal pain, often accompanied by osteomyelitis.
Visceral abscesses.Liver abscesses. The liver is an intra-abdominal organ in which abscesses occur most often. Most common symptom- fever. Only half of the patients have signs that draw attention to the right upper quadrant; these are hepatomegaly, tenderness on palpation and jaundice.
Splenic abscesses. They are often discovered only at autopsy. They occur hematogenously. Most common concomitant disease- bacterial endocarditis. Abdominal pain is reported by 50% of patients, but in only half of them it is localized in the left upper quadrant. Fever is typical, splenomegaly was noted in 50% of patients.
Paranephritis and kidney abscesses usually occurs against the background of a primary infection urinary tract. Symptoms are nonspecific. There may be pain in the abdomen, in particular in its lateral sections; 50% of patients have fever. The pain may radiate to groin area or to the lower limb.
Diagnostics: Ultrasound usually helps in diagnosis, CT is most effective. Ultrasound is very valuable in localizing the pathological process in the right upper quadrant, kidneys, and pelvis. Highly efficient scanning using gallium and indium labeled leukocytes.
Treatment: Includes: identifying the original source of infection, prescribing effective antibiotics, draining foci of infection. Antibacterial therapy secondary to drainage (percutaneous or through an incision) and is aimed at pathogens; These are usually anaerobes or aerobic gram-negative bacteria.