Aseptic peritonitis - the defeat of a peritoneum arising owing to action of noninfectious factors (enzymes of a pancreas, a congestion of blood, bile, urine at ruptures of internals, injuries), which is followed by the expressed violation of work of vitals. Due to the features of pathogenesis the disease soon gains infectious and inflammatory character, has bystry development of a clinical picture with considerable deterioration in a condition of the patient. Diagnostics is based on assessment of symptomatology, results of a X-ray analysis and BONDS scanning of an abdominal cavity, a diagnostic laparoscopy. The most important factor of successful treatment is performing timely surgery. In the postoperative period intensive therapy continues.
Aseptic peritonitis – a peritoneum inflammation which develops owing to a rupture of not infected hollow bodies and educations (for example, a gall bladder, cysts of ovaries, a bladder), the injuries of a stomach which are followed gemoperitoneumy (a blood congestion in an abdominal cavity), and also enzymatic impact on a peritoneum at sharp pancreatitis. Features of this pathology are defined by a peculiar answer of an organism at influence of the pathogenic agent on a peritoneum that leads to development of heavy symptomatology, the expressed defeats of bodies and systems.
Existence of an aseptic form of peritonitis is possible only for the short period of action of the damaging factor which has the noninfectious nature. Bile, blood, urine, pancreatic enzymes in an abdominal cavity lead to development of toksiko-chemical damage of a peritoneum, inflammatory process develops, and in view of the increased permeability of walls of intestines of a bacterium easily get into a peritoneum cavity.
Reasons of aseptic peritonitis
The complication of sharp pancreatitis, pankreonekroz is the most frequent reason of development of aseptic peritonitis in gastroenterology. Enzymatic pankreatogenny peritonitis accompanies about 70% of cases of destructive pancreatitis. Also the rupture of internals with hit in an abdominal cavity of blood, bile, urine can be the cause of this pathology. In response to their influence in a peritoneum the inflammation develops, there are essential changes of a vascular wall, exudate and fibrin is emitted. At penetration of microorganisms the bacterial inflammation joins.
Development of a disease differs depending on the reason, prevalence of process in an abdominal cavity, reactivity of an organism of the patient. Influence of the pathological agent is resulted by paralytic intestinal impassability, vsasyvatelny ability is broken, blood vessels extend that leads to the strengthened release of liquid in a gleam of intestines and to metabolic violations.
Further development of an inflammation provokes blood circulation centralization. Expansion of vessels of intestines leads to redistribution of blood and its congestion in the field, perfusion of vitals worsens (kidneys, lungs, a liver), their functions are broken. At the following stage violation of absorption in intestines is replaced by its significant increase, there is a resorption of toxic substances from an intestines gleam that aggravates intoxication.
Depending on prevalence of pathological process in an abdominal cavity aseptic peritonitis can be local or poured. On character of exudate distinguish hemorrhagic, serous, fibrinozny, bilious type, on disease severity – three degrees. Also differentiate three stages of peritonitis: jet (lasts for the first 24 hours), toxic (24-72 hours), terminal (after 72 hours).
Symptoms of aseptic peritonitis
The clinical picture of a disease is various and in many respects is defined by an etiologichesky factor. However it is possible to allocate characteristic symptoms which are caused by time from the beginning of a disease, defeat of other bodies, homeostatic shifts.
In the first days of a disease (a jet stage) local manifestations prevail, at the same time the general condition of the patient can remain not heavy. There are constant severe pains in a stomach amplifying at the movements, cough, decreasing in a prone position on one side with the given legs. Localization of pain, as well as its intensity, can be various. It depends on prevalence of process, and also the main disease. The speeded-up pulse is defined, arterial pressure significantly does not change. At a palpation of a belly wall morbidity in a process localization zone is characteristic. Temperature is subfebrilny. In blood tests - insignificant with neytrofilny shift.
In a toxic stage the general reactions of an organism, an intoksikatsionny syndrome prevail. At the expense of the accruing intoxication the symptomatology of the main disease disappears. Belly-ache, tension of a belly wall weaken. There are symptoms of paralytic intestinal impassability. The abdominal distension is defined, peristaltic noise disappear. Considerably pulse rate – 130-140 blows in a minute increases. The tendency to a lowering of arterial pressure is observed. Body temperature is higher than 38 degrees. In blood – with the expressed neytrofilny shift. The general condition of the patient considerably suffers.
The terminal stage is followed by an adinamiya, confusion of consciousness. Pallor of skin, pointedness of features is characteristic. There is respiratory short wind, symptoms of a renal, liver failure. There can be plentiful vomiting stagnant contents. The sharp abdominal distension, the expressed morbidity is noted. Pulse of more than 140 in a minute, arterial pressure is considerably reduced. Such clinical picture is predictively an adverse sign.
Diagnosis of aseptic peritonitis
The diagnosis in a toxic, terminal stage usually does not raise doubts in view of characteristic symptomatology. Difficulties can arise at the initial stages when the clinic is defined by the main disease.
The X-ray analysis of an abdominal cavity allows to define availability of free liquid, signs of paralytic impassability of intestines. Tonkokishechny "arches" with liquid levels, internal contours of intestines indistinct are visualized, folds mucous are thickened. Ultrasonography also allows to visualize free liquid in an abdominal cavity, structurally functional changes of intestines.
Informative method of diagnostics is the laparoscopy giving the chance to examine the most part of an abdominal cavity, to estimate a condition of a visceral, parietal peritoneum, to define availability of exudate and its character.
Treatment of aseptic peritonitis
Not the gastroenterologist, but the abdominal surgeon is engaged in treatment of aseptic peritonitis. The most important factor of successful treatment is early surgical intervention. In view of the expressed disease symptomatology recognition of its concrete reason before operation often does not make sense as is only a waste of time. Before surgical intervention short intense training is carried out. Correction of dekompensirovanny functions of an organism, restoration of volume of the circulating blood is made. During operation the peritonitis reason is established, removal of pathological contents from a peritoneum cavity is carried out, its sanitation, a digestive tract decompression, conditions for a possibility of sanitation of a cavity in the postoperative period are created.
Sanitation of an abdominal cavity in the course of operation is carried out by a peritonealny unleavened wheat cake. Washings are made by warm solutions of anti-septic tanks to clear water, at the same time fibrin naplastovyvaniye are removed. For an unleavened wheat cake solutions of antibiotics, lizotsy can be used, heparin, is applied ultrasonic processing of an abdominal cavity.
In the postoperative period intensive therapy continues. Prescription of antibiotics, immunomodulators is obligatory. Infusional therapy for the purpose of restoration of volume of the circulating blood, corrections of electrolytic violations, improvements of rheological properties is performed. The active detoxication is reached by use of blood substitutes, the forced diuresis, haemo sorptions, peritonealny dialysis. An important stage of treatment – restoration motor functions of intestines. Also maintenance of the vital functions of an organism is carried out.
Forecast and prevention of aseptic peritonitis
Aseptic peritonitis is a serious illness. However at full complex treatment, timely surgical intervention, elimination of a source in most cases the outcome favorable, comes recovery. Prevention consists in early adequate treatment of the main disease.