This is an automatically translated article.
Article written by Doctor Le Van Binh - Department of Intensive Care - Vinmec Times City International General Hospital.
Peritonitis is redness and swelling (inflammation) of the tissue lining your abdomen or abdomen. This tissue is called the peritoneum. This can be a deadly disease if not treated promptly and properly. The disease occurs not only in adults but also in children.
1. Overview of peritonitis
Peritonitis is inflammation of the parietal - visceral peritoneum due to infectious or non-infectious causes.
Peritonitis includes:
Primary peritonitis. Secondary peritonitis. Combined peritonitis (patient on hemodialysis). Causes of peritonitis can be due to:
Infection: Gastrointestinal perforation, trauma, primary. Non-infectious: Abdominal aseptic surgery, sterile fluid leak into the abdomen, rare disease,...
2. Clinical manifestations
2.1. Function
Abdominal pain: Pain spreads throughout the abdomen (in the early stages, depending on the cause, it may be localized). Vomiting and nausea.
2.2. Body
Symptoms of infection: High fever, fatigue, if the patient is exhausted, there may be no fever or low fever. Electrolyte dehydration: Dry lips, dry skin, thirst,... Intoxication: Fatigue, pale skin, pale, lethargy,... Pulse, blood pressure: Fast, small pulse, blood pressure often drops, There may be signs of shock.
2.3. Entity
Abdominal distension of various degrees, mild to very distended. Abdomen is less mobile with breathing, sometimes not moving, abdominal wall muscles may float in older children. Abdominal wall palpation: The abdomen is partially or completely rigid.
Abdominal wall reaction (+). The deeper it is, the more painful it is.
Peritoneal induction is often in the late stage.
Abdominal percussion: Usually low turbidity. Rectal examination: The sac with Douglas is full and painful. Lumbar puncture: Often there is turbid fluid, pus, bile, blood,... depending on the cause of peritonitis.
3. Subclinical
3.1. Test
Blood leukocytes are elevated, neutrophils are high. Hemoconcentration (may or may not occur). Peritoneal leukocytes >250 polymorphonuclear leukocytes/ml. Peritoneal fluid culture, PCR with bacteria.
Xét nghiệm máu giúp chẩn đoán viêm phúc mạc.
3.2. Image analysation
Ultrasound: Can see abdominal fluid, the cause of peritonitis. Abdominal X-ray: Low opacity of the abdomen, thickened bowel wall, dilated bowel loops.
Laurelle's sign: Fluid layer between the abdominal wall and the ascending and descending colon.
Possible cause of peritonitis.
4. Diagnosis
4.1. Implementing the quadrants
Clinical Abdominal pain
Abdominal wall spasticity (abdominal wall reaction).
Peritoneal induction.
Rectal examination: bulging, painful Douglas pouch.
Subclinical: WBC >250 polymorphonuclear leukocytes/ml is the most important criterion for infectious peritonitis. Elevated white blood cells : The neutrophil rate increases.
Symptoms specific to each cause: Visceral perforation, primary peritonitis, biliary peritonitis.
4.2. Differential diagnosis
Injury to the abdominal wall. Other infections and poisonings: Especially in the gastrointestinal tract.
5. Treatment
Principles of treatment:
Primary peritonitis usually requires only medical treatment, including: Fluid rehydration, water and electrolyte adjustment, acid-base.
Antibiotics: Broad spectrum, Gram-negative susceptibility is preferred. Metronidazole anaerobic antibiotic.
Secondary peritonitis: Usually, combined surgical treatment is needed to treat the cause of peritonitis. Peritonitis is a dangerous disease that can leave severe sequelae and has a high risk of death. Therefore, when seeing a child with abnormal signs, parents need to immediately take the child to a medical facility for examination.
Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading medical doctors, modern equipment and technology, but also stands out for its examination and consultation services. comprehensive and professional medical consultation and treatment; civilized, polite, safe and sterile medical examination and treatment space.
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Reference article:
Biology online’s definition of peritonitis. Retrieved, 2008. Peritonitis, Merek manual Hane Edition. Retrieved, 2008. Peritonitis, Pediatric gastrointestinal disease, 5th edition, 2008.
