What can you eat after surgery peritonitis. Peritonitis. postoperative complications. Informative diagnostic methods

Inflammation of the peritoneum is called. This condition is extremely dangerous for the body, as it disrupts the functioning of all vital organs. Acute peritonitis requires urgent medical attention, otherwise it can be fatal in a short time.

Peritonitis can be primary or secondary. Primary peritonitis abdominal occurs rarely (more often in children) and is caused by damage to the peritoneum by microorganisms that have penetrated the hematogenous, lymphogenous way or through the uterine (fallopian) tubes. Secondary peritonitis occurs as a result of the spread of infection from various organs of the abdominal cavity when they are inflamed, perforated, or damaged.

Causes of peritonitis

Peritonitis develops when an infectious (less often viral) agent enters. The peritoneum does not have its own protective capabilities, the inflammation spreads quickly, a huge amount of toxins is produced, which quickly poison the entire body.

Pathogenic microorganisms most often get on the peritoneum from internal organs, which for some reason (trauma, surgery, perforation) have lost their tightness, and their contents got into the abdominal cavity, causing inflammation, suppuration, decay there. Sometimes the cause of peritonitis lies in the intracavitary factor.

Bowel dysfunction plays an important role among other causes of peritonitis. Different kinds intestinal obstruction in their final stage with developed intestinal necrosis, acute pancreatitis, thrombosis of the mesenteric vessels and perforation of tumors of the gastrointestinal tract, gynecological diseases can cause peritonitis.

From a clinical point of view, alcoholic peritonitis is interesting, the pathogenetic cause of which may lie in the Mallory-Weiss syndrome, in a toxic perforated ulcer and other conditions. Such peritonitis is interesting in that it very rarely causes typical or at least alarming symptoms, leading to death or serious complications.

Classification of peritonitis

Peritonitis is primary and secondary.

Primary, aka idiopathic or viral peritonitis, occurs extremely rarely, as a result of a primary infection of the abdominal cavity and peritoneum. In the case of viral peritonitis, the infection enters the peritoneum by hematogenous route, or through the lymphatic vessels, occasionally through the fallopian tubes. Viral peritonitis accounts for no more than 1% of all cases of the disease.

Depending on the reason, there are:

• Infectious peritonitis;
• Perforated peritonitis;
• Traumatic peritonitis:
• Postoperative peritonitis.

By the nature of the inflammatory exudate:

• Serous peritonitis;
• Purulent peritonitis;
• Hemorrhagic peritonitis;
• Fibrinous peritonitis;
• Gangrenous peritonitis.

By the degree of distribution:

• Local peritonitis;
• Widespread peritonitis;
• General (total) peritonitis.

By localization:

• Delimited (encapsulated) peritonitis;
• Spilled peritonitis.

By traumatic factor:

Acute diffuse peritonitis in most cases develops as a complication of various diseases of the abdominal cavity - perforated ulcer of the stomach, intestines, purulent appendicitis, thrombosis of mesenteric vessels, liver abscess, etc. The causative agent of the inflammatory process in the peritoneum is the intestinal microflora: Escherichia coli in combination with streptococci, staphylococcus dysentery sticks.

In accordance with etiological factors, the following forms of the disease are distinguished:

• perforated diffuse peritonitis - associated with a perforated ulcer of the stomach, duodenum, large and small intestines;
• bilious peritonitis - occurs as a result of perforation of the gallbladder, and in some cases without it;
• septic peritonitis - postpartum.
• pneumococcal peritonitis - occurs in pneumonia, in patients with severe nephritis, etc.
• postoperative peritonitis;
• traumatic peritonitis - associated with mechanical trauma, injury with a cold weapon or firearms.

Pain is a constant symptom of acute diffuse peritonitis. Severe pains force the patient to go to bed. They sharply increase with the slightest movement, coughing, concussion. The patient's face is pale, cold clammy sweat appears on the forehead, blood pressure falls, the pulse becomes threadlike. In the future, intense pain may subside, especially during the period of accumulation of exudate in the abdominal cavity. Discharge of feces and gases ceases, absence of peristalsis. In this case, vomiting and persistent hiccups are observed. In the early stages from the onset of the development of the disease, the vomit contains food debris. In advanced cases of the disease, vomiting can become fecal.

Acute purulent peritonitis

The causes of acute purulent peritonitis can be:

• An inflammatory disease of any of the abdominal organs (acute appendicitis, cholecystitis, strangulated hernia, inflammation of the internal genital organs in women, etc.), in which the infection spreads from the main focus to the peritoneum.
• Perforation of the abdominal organs (perforated stomach ulcer, perforation of typhoid ulcer of the small intestine, etc.), as a result of which the infected contents are poured into the abdominal cavity and cause peritonitis.
• Injuries to the abdominal organs, which include not only penetrating wounds of the abdominal wall and abdominal organs, but also some blunt (closed) damage to these organs, such as the intestines. In both of these cases, pyogenic microbes penetrate the abdominal cavity and cause the development of an acute purulent inflammatory process in it.
• Hematogenous (i.e., by blood flow) spread of infection to the peritoneum from some distant inflammatory focus, for example, with angina, osteomyelitis, sepsis, which, however, is very rare.

Thus, peritonitis is always a secondary disease that occurs most often as a complication of any inflammatory process, perforation or damage in the abdominal cavity. That is why in case of inflammation of the peritoneum, one cannot be limited to the diagnosis of "peritonitis", but it is necessary to establish its primary source, which is actually the primary disease, and peritonitis is only its complication. True, this is often possible only in the initial stage of peritonitis or during surgery.

Biliary peritonitis

Bile peritonitis is most often caused by acute inflammation of the gallbladder, usually caused by a pinched stone and the presence of a virulent infection, the gallbladder is greatly enlarged, and bile contains flakes or pus and is dirty yellow or gray. The disease is often complicated by acute cholangitis, due to the spread of the infection to the biliary tract. Bile may ooze from the bed of the bladder. An increase in pressure in the bile duct, for example, due to an unremoved stone of the common bile duct, increases the flow of bile, the accumulation of which around the biliary tract contributes to the development of their stricture.

The severity of symptoms depends on the extent of the spread of bile in the abdominal cavity and its infection. The ingress of bile into the free abdominal cavity leads to severe shock. Bile salts chemically irritate the peritoneum, which causes the exudation of large volumes of plasma into the ascitic fluid. The outpouring of bile is accompanied by severe diffuse pain in the abdomen. On examination, the patient is motionless, the skin is pale, there is low blood pressure, persistent tachycardia, board-like rigidity and diffuse pain on palpation of the abdomen. Intestinal paresis often develops, therefore, in patients with unexplained intestinal obstruction, biliary peritonitis should always be excluded. A few hours later, a secondary infection joins, which is manifested by an increase in body temperature against the background of persisting pain in the abdomen and its soreness.

Peritonitis with appendicitis

Late admission of patients, late diagnosis are the most common causes of complications in acute appendicitis. In the first two days with inflammation of appendicitis, it is characterized by the absence of complications, the process usually does not go beyond the process, although destructive forms and even perforation can be observed, especially often in children and the elderly. On days 3-5, usually there are: perforation of the appendix, local peritonitis, thrombophlebitis of the veins of the mesenteric appendix, appendicular infiltration. After 5 days, the following are observed: diffuse peritonitis, appendicular abscesses, portal vein thrombophlebitis - pylephlebitis, liver abscesses, sepsis.

Inflammation of the appendix develops into inflammation of the peritoneum in 10-15% of cases. This is the development of events that doctors are afraid of, and it is for this reason that they try to be careful with pain in the abdominal region. The difference between the two diseases is that the signs of peritoneal inflammation are more pronounced. They are somewhat similar to the signs of appendicitis, but they manifest themselves with greater intensity, so in this case, doctors have much less doubts about the diagnosis.

Peritonitis after surgery

Peritonitis is a common and severe complication after surgery on the abdominal organs. The cause of its occurrence is most often: the failure of the anastomosis sutures, the duodenal stump, destructive changes on the part of the abdominal organs (acute pancreatitis, necrosis of the wall of the stomach or intestines with an incorrect assessment of their viability, perforation of acute ulcers, acute mechanical intestinal obstruction, etc.), infection abdominal cavity during the operation or its defective sanitation in those operated on for peritonitis.

There is no universal clinical picture of postoperative peritonitis. The difficulty in diagnosing such a complication lies in the fact that the patient underwent surgery and is already in serious condition, is intensively treated with medications, including antibiotics, hormones, and receives pain relievers. The situation becomes more complicated if the patient has been operated on for peritonitis (for example, peritonitis after perforated appendicitis or perforated gastric ulcer, duodenal ulcer). Here, it is fundamentally important to distinguish the newly emerged postoperative peritonitis from the existing (ongoing) peritonitis, for which the patient was operated on. Especially difficult is the diagnosis of postoperative peritonitis in elderly patients, emaciated, with a severe course of the underlying or concomitant disease.

The main thing in the diagnosis of postoperative peritonitis is the early detection of this complication before the development of classic, pronounced symptoms, starting with "Facies Hyppocratica", "plank-shaped abdomen", including numerous symptoms of peritoneal irritation, when peritonitis becomes widespread (diffuse) and passes in its development from the phase absence of signs of sepsis in the sepsis phase.

There are no absolute signs that make it possible to recognize the onset of the development of peritonitis in the postoperative period. Therefore, much depends on the correct organization of dynamic monitoring of the patient in the postoperative period using clinical and laboratory tests to identify a progressive increase in endogenous intoxication.

Peritonitis symptoms

Inflammation of the peritoneum is roughly indicated by an enlargement of the torso, strenuous walking, a sudden deterioration in diseases of the abdominal organs.

Acute peritonitis is a generalized disease with high fever and very high leukocytosis (100 thousand cells and more in 1 mm3). The abdomen is tucked up, tense and painful. Urination and defecation are impaired, often absent. Sometimes there is vomiting, tenesmus, rapid breathing, shallow, chest type. Sunken eyes, mucous membranes of red color, capillary filling rate over 2 s. Pulse rapid, small filling, up to threadlike. The fluid aspirated during laparocentesis is cloudy, serous, purulent or bloody, containing fibrin flakes.

In chronic peritonitis, all of the above symptoms may not be detected. The animal is apathetic, sleepy, the abdomen is slightly enlarged, saggy. Therefore, chronic peritonitis is often diagnosed only with laparotomy (opacity of the peritoneum, thickening, plaque, spot bleeding).

On the other hand, the status of the blood is indicative for both courses of peritonitis (accelerated ESR, leukocytosis with a hyperregenerative shift of the nucleus to the left until the appearance of young and young cells).

Acute peritonitis has several phases of development:

• The reactive phase lasts 12 to 24 hours;
• Toxic phase, duration from 12 to 72 hours;
• The terminal phase occurs after an interval of 24 to 72 hours from the onset of the disease and lasts several hours.

Thus, acute peritonitis can be fatal within 24 hours of onset.

Peritonitis treatment

With peritonitis, an urgent operation is needed. The consequences of treatment directly depend on the urgency of the surgical intervention. The operation consists in removing the focus of inflammation, sanitation of the abdominal cavity, and its drainage. At the same time (as well as in the postoperative period), the restoration of the water-electrolyte balance, the functions of organs and systems, damage to which is inevitable during peritonitis, is carried out.

After the operation, antibiotics, massive infusion therapy are prescribed, aimed at restoring immunity, gastrointestinal functions, and preventing complications.

General principles of peritonitis treatment:

• possibly earlier elimination of the focus of infection during surgery;
• evacuation of exudate, flushing of the abdominal cavity with antibacterial drugs and adequate drainage of it with tubular drains;
• elimination of paralytic intestinal obstruction by aspiration of contents through a nasogastric tube, decompression of the gastrointestinal tract, the use of drugs;
• correction of volemic, electrolyte, protein deficiencies and acid-base state with the help of adequate infusion therapy;
• restoration and maintenance of kidney, liver, heart and lung function at an optimal level;
• adequate antibiotic therapy.

Appendix - This is a process of the cecum, and its inflammation is called appendicitis. It can be caused by kinks of the appendix with its excessive mobility (often in children), blockage of its lumen with feces and undigested particles, infections, abdominal trauma and inflammatory bowel disease.

Treatment of this disease is only operative - removal of the appendix. The most common surgical procedure is conventional appendectomy , in which the appendix is \u200b\u200bremoved through a conventional incision. Endoscopic surgery is used less often, but provides less blood loss and trauma, since a small incision is made.

Inflammation of the appendix that is not diagnosed in time and is not eliminated can cause serious complications, which include appendicular infiltrate and peritonitis ... With appendicular infiltrate, when not only the appendix is \u200b\u200binvolved in the inflammatory process, but also the adjacent formations (small intestine, omentum, cecum), conservative treatment is first carried out in a hospital setting, and after resorption of the infiltrate after 2 months, a planned appendectomy .

The formation of infiltrates is determined by the individual reaction to the focus of inflammation in appendicitis. In some patients, the inflammatory-destructive process is delimited (in the form of an infiltrate), while in others it develops a diffuse peritonitis (inflammation of the peritoneum). Peritonitis occurs with destructive forms of appendicitis, and is observed with untimely treatment, in the elderly and with intestinal pathology. Its development complicates the course of the operation, with peritonitis, the intestines and abdominal cavity are sanitized, drainage is applied for a constant outflow of the discharge. A more serious, complex treatment is prescribed in the postoperative period.

The recovery period lasts from the moment of surgery until the removal of the stitches. At this time, the restoration of body functions (defecation, urination) and the state of the postoperative sutures are monitored. Recovery is different for everyone, but faster for young and thin patients. Its duration increases if it was difficult appendectomy ... During this period, nutrition plays an important role at all stages.

In the postoperative period, a zero or surgical diet is prescribed. These are three gradually prescribed diets, which form a unified nutritional system in the first week after surgery.

The goal of prescribing a zero diet is to:

• maximum unloading of the digestive organs and their sparing;
• warnings.

Nutrition after appendicitis removal

It is characterized by the maximum mechanical and chemical sparing of the organs, since the patient is allowed to consume only liquid, semi-liquid, pureed and jelly-like dishes. Restrictions on salt are introduced. The diet consists of light and highly digestible foods, low in protein, fat and carbohydrates, the amount of which gradually increases over the course of the week. Accordingly, the power consumption of food also increases.

So, start eating with a diet that contains only 5 g of protein, 150 g of carbohydrates and 15 g of fat. From the third day, the diet expands and already includes 40 g of proteins, the same amount of fat, 250 g of carbohydrates, the amount of salt increases slightly. And after another 2 days, the patient can already consume up to 90 g of proteins, 70 g of fat and the physiological norm of carbohydrates (350 g). Drinking plenty of fluids is recommended all these days. Nutrition after surgery involves frequent meals, first in small portions (100-200 g in adults and 50 g in children) with a gradual increase in volume up to 300 g per dose.

Begin eating with Diet number 0A ... Only liquid and jelly-like dishes (jelly) are allowed. Recommended seven to eight meals a day. By day it looks like this:

First day

• strained compote;
• sweet rosehip broth;
• weak sweet tea;
• weak meat broth;
• decoction of rice;
• berry jelly (strained);
• fresh juices diluted with water 2 times (50 ml per dose).

The consumption of sour cream, whole milk, mashed potatoes, grape juice and vegetable juices, drinks with gas is prohibited. Vegetables and milk can cause bloating, which is highly undesirable after bowel surgery. Further food is organized within Table number 0B , which is prescribed for 2-4 days (depending on the patient's condition). At one time the patient can eat 350-400 g of food. Six meals a day.

Second and third day

• liquid and mashed porridge ( oat flakes, rice, buckwheat) in meat broth or broth diluted with water;
• slimy cereal soups;
• weak meat broths with the addition of semolina;
• steam omelets and soft-boiled eggs;
• steam meat and fish soufflés and meat and fish puree are not fatty varieties;
• cream (100 g, added to dishes);
• berry jellies and mousses from non-acidic berries.

Fourth and fifth day

• mashed soups;
• pureed fresh cottage cheese (add cream or milk);
• meat, fish and chicken, ground in a meat grinder (added as minced meat to dishes);
• curd dishes (steam);
• 100 g white crackers;
• dairy products;
• mashed zucchini, potatoes and pumpkin;
• baked apples;
• mashed milk porridge;
• mashed fruits and vegetables;
• tea with milk.

Eating after peritonitis does not differ from the above, the only difference is that the transition from one variant of the surgical diet to another is more delayed in time due to the serious condition of the patient. After completing three options for zero diets, the patient, depending on the state of health, is transferred to a standard or No. 1 surgical ... It differs from Diet # 1 in that it includes weak meat and fish broths and limits milk intake. Nutrition issues are discussed with the attending physician.

The diet after the removal of appendicitis should be followed for a month, and with complications and concomitant diseases of the digestive tract and more. These questions are discussed with the doctor. During this time, the food should be easily digestible.

• fractional and frequent meals;
• lean fish, chicken or beef, which are cooked by boiling;
• good nutrition in terms of protein content, vitamins and minerals;
• limit heavy fats, give up fatty meats, smoked meats, any sausages, mayonnaise, hot sauces;
• exclude foods that promote fermentation and gas formation (coarse vegetables, legumes, any varieties of cabbage, carbonated drinks).

After surgery for appendicitis, the patient within 3 months should not:

• ignore wearing a bandage;
• perform unacceptable physical activity.

Within 1.5 months, muscle fusion occurs and the risk of hernias remains, therefore, after removing the appendix, lifting weights is prohibited. But daily not brisk walking (up to 2-3 km per day) is indicated, as it prevents the appearance of adhesions.

Allowed Products

• Mashed soups are prepared in water or a weak meat broth from oatmeal, buckwheat, semolina, and rice groats. In soups, you can add an egg-milk mixture, in a small amount of cream (50-100 ml) and butter (5 g). From the fourth day, boiled chopped meat, after 7-9 days meatballs.
• White crackers 75-100 g per day.
• Meat and poultry are first prepared in the form of a souffle, a little later in the form of cutlets and dumplings, a month after the operation, you can eat lumpy meat.
• Fish is also prepared in the form of soufflé, twisted boiled minced meat, and then in the form of cutlets, meatballs and dumplings. For cooking, choose lean fish (cod, hake, pike, blue whiting, pollock, ice).
• Porridge is prepared in mashed semi-liquid form, adding milk and butter.
• From the fourth, potato, pumpkin, carrot, squash and beetroot puree is introduced, for the preparation of which cream or milk and butter are used. If desired, vegetable dishes are replaced with vegetable baby food.
• Eggs are consumed daily (soft-boiled or steamed scrambled eggs).
• Milk is used to add to cereals, in tea, you can eat mashed cottage cheese daily, adding milk or cream. Cream is also added to soups or tea. Consumption of these products in kind is not permitted due to the potential for development flatulence .
• Berries are used to make jelly and jelly. Apples are consumed only baked or stewed, and only by the end of the month can they be consumed fresh.
• Honey and sugar (40-50 g).
• Butter (butter) is added to dishes.
• You can drink weak tea with milk and cream, herbal teas, diluted juices of berries, rosehip infusion.

Approved Products Table

	Proteins, g	Fat, g	Carbohydrates, g	Calories, kcal
Cereals and cereals
buckwheat (unground)	12,6	3,3	62,1	313
semolina	10,3	1,0	73,3	328
oat flakes	11,9	7,2	69,3	366
rice white	6,7	0,7	78,9	344
Confectionery
jelly	2,7	0,0	17,9	79
Raw materials and seasonings
sugar	0,0	0,0	99,7	398
Dairy
milk	3,2	3,6	4,8	64
cream	2,8	20,0	3,7	205
Cheese and curd
cottage cheese	17,2	5,0	1,8	121
Meat products
boiled beef	25,8	16,8	0,0	254
boiled veal	30,7	0,9	0,0	131
rabbit	21,0	8,0	0,0	156
Bird
boiled chicken	25,2	7,4	0,0	170
turkey	19,2	0,7	0,0	84
Eggs
chicken eggs	12,7	10,9	0,7	157
Oils and fats
butter	0,5	82,5	0,8	748
Non-alcoholic drinks
mineral water	0,0	0,0	0,0	-
black tea with milk and sugar	0,7	0,8	8,2	43
Juices and compotes
the juice	0,3	0,1	9,2	40
jelly	0,2	0,0	16,7	68
rosehip juice	0,1	0,0	17,6	70

Fully or partially limited products

Diet after appendicitis provides for an exception from the diet:

• beans, peas, beans, lentils, cabbage, which cause gas formation and can provoke intestinal colic;
• salt for 2 weeks (or sharply limit);
• for a month or more smoked meats, fried foods, fatty meats, coarse meats, sausages (smoked and boiled), mayonnaise, ketchup and sauces, fatty fish, salted and smoked fish;
• mushrooms (as a difficult to digest product);
• carbonated and alcoholic drinks, strong tea and coffee;
• sauces, vinegar, ketchup, mayonnaise and condiments.

Prohibited Products Table

	Proteins, g	Fat, g	Carbohydrates, g	Calories, kcal
Vegetables and greens
vegetables	2,5	0,3	7,0	35
horseradish	3,2	0,4	10,5	56
Cereals and cereals
corn grits	8,3	1,2	75,0	337
pearl barley	9,3	1,1	73,7	320
millet groats	11,5	3,3	69,3	348
barley grits	10,4	1,3	66,3	324
Bakery products
white bread crackers	11,2	1,4	72,2	331
wheat bread	8,1	1,0	48,8	242
Confectionery
jam	0,3	0,2	63,0	263
sweets	4,3	19,8	67,5	453
Ice cream
ice cream	3,7	6,9	22,1	189
Raw materials and seasonings
mustard	5,7	6,4	22,0	162
ketchup	1,8	1,0	22,2	93
mayonnaise	2,4	67,0	3,9	627
ground black pepper	10,4	3,3	38,7	251
chilli	2,0	0,2	9,5	40
Dairy
kefir	3,4	2,0	4,7	51
sour cream	2,8	20,0	3,2	206
curdled milk	2,9	2,5	4,1	53
Meat products
pork	16,0	21,6	0,0	259
Sausages
sausage with / dried	24,1	38,3	1,0	455
sausages	12,3	25,3	0,0	277
Bird
smoked chicken	27,5	8,2	0,0	184
duck	16,5	61,2	0,0	346
smoked duck	19,0	28,4	0,0	337
goose	16,1	33,3	0,0	364
Fish and seafood
dried fish	17,5	4,6	0,0	139
smoked fish	26,8	9,9	0,0	196
canned fish	17,5	2,0	0,0	88
Oils and fats
cream margarine	0,5	82,0	0,0	745
animal fat	0,0	99,7	0,0	897
cooking fat	0,0	99,7	0,0	897
Non-alcoholic drinks
black tea	20,0	5,1	6,9	152
* data are indicated for 100 g of product

Menu (Power Mode)

The nutritional menu after surgery reflects the gradual expansion of the diet and the amount of food consumed. Of course, in the first week (or more), the food is non-nutritive and does not correspond to the physiological norms of a healthy person. However, it is enough for a patient who has undergone surgery and is on bed rest. A gradual increase in the food load on the digestive organs trains them and prepares them for a nutritious diet. Below is the menu by day.

Doctors call appendicitis a disease of the appendix, which requires surgery as quickly as possible. It is the most common organ disease in the abdominal cavity. If a person has acute appendicitis, then he needs to immediately call ambulance... If appendicitis is not cured, then peritonitis can develop - a deadly complication. But even in this case, it is possible to carry out the operation.

Appendicitis is an inflammation of the appendix, that is, the part of the large intestine that is located on the right, in the abdominal cavity. No one still knows what role he plays. Some people think that it has any effect on protecting the intestines from certain bacteria. But it is not known exactly why appendicitis occurs. In order for it to arise, two factors are necessary:

1. The presence of some bacteria in the intestines.
2. The lumen of the appendix is \u200b\u200bclogged, which can happen due to spasms or a foreign body that has entered the intestines. This is due to the fact that fecal matter can penetrate into that lumen and harden, which contributes to the occurrence of infection. The same reason can be the intake of seeds from berries and fruits or seeds.

Signs of appendicitis

Most often, they depend on how old the patient is, how the appendix is \u200b\u200blocated. There are several typical signs of this condition.

• Abdominal pain ... This is the first and main symptom of acute appendicitis that has arisen. As a rule, the patient complains of a dull pain in the upper abdomen, then the pain begins in the right side. They are joined by a headache and severe weakness, sometimes legs hurt.
• Temperature the body rises to 38 degrees, is not very high, but helps to distinguish appendicitis from some other diseases.
• Appears nausea, vomiting ... As a rule, along with pain with appendicitis, nausea appears, which soon begins to be accompanied by vomiting, and diarrhea sometimes begins in children.

If a person has all these symptoms, then he should not use pain relievers, because against the background of this, the disease can become complicated.

Operation

Surgical intervention is performed in such a way that the appendix is \u200b\u200bexcised from the patient under local anesthesia. If the appendix has not ruptured, then the operation takes about forty minutes, after which sutures are applied. Now the skin is not always cut, but it can be pierced, which will allow the patient to speed up recovery. This is possible if the appendicitis has not ruptured.

If there are no complications, then after a week you can start your usual business. The stitches are removed around the tenth day. After that, you can walk, get up, move as usual. A small scar remains on the abdomen, which may remain red in the first year, and then turn pale and become less noticeable. After the operation, it is better not to engage in physical activity and limit your sex life.

Diet after removal of appendicitis and peritonitis

During the operation, the appendix is \u200b\u200bremoved, which violates the integrity of the intestine, and doctors have to put stitches. Eating regular food immediately after surgery increases the likelihood that the stitches may come apart. It is clear that food should be special.

On the first day after the operation, a person is recovering from anesthesia, and it is unlikely that he is hungry. And the intestines need time to start functioning normally again. Therefore, immediately after the operation, it is recommended just drink a little water ... According to the situation, the doctor may allow the use of broth, rice broth or tea.

On the second or third daydoctors allow eat fractionally, in small portions , about five times a day. You can not eat those foods that can lead to gas formation and increase suture inflammation. Food can be like jelly and should be taken only warm. Recommended for use chicken broth, yogurt without dyes and additives, squash or pumpkin puree, chicken puree, rice broth, mashed potatoes... Sometimes doctors advise eating foods that contain fiber, such as baked apples or boiled carrots.

In the first week after surgery it is necessary to normalize the stool. After the first three days, the diet is usually expanded to include foods containing fiber ... These include porridge on the water made from cereals, berries and fruits prepared steamed, vegetables, dried fruits, cream soups, lean meats and fish, butter, dairy products. The main thing, eat thoroughly until the consistency is pasty and not too dry.

Dishes should be consumed in small portions, every two to three hours. In addition, you also need drink enough water , because otherwise you may experience discomfort. In the absence of contraindications from the cardiac side, then you can drink up to ten glasses a day. Most of this liquid should be plain water.

It is also worth exclude the use of foods such as spices, legumes, dairy and fatty ... The point of this diet is to create the necessary conditions for faster wound healing and improved peristalsis.

After the first week passes, the diet expands further.... You can use absolutely any soup with chicken or vegetable broth, but without frying. You can add onions, beets, zucchini, potatoes, just before using this, it is better to pass through a blender.

Mushrooms, omelets with fish or vegetables, pasta casserole, porridge cooked in water, to which you can add butter, are suitable as second courses. Do not use additives such as mayonnaise, ketchup, horseradish, mustard and other spices with seasonings.

A month later, you can start using legumes after the patient has undergone surgery. It is not recommended to eat sweets, pastries, baked goods and cakes earlier than a month after. Everything heals completely only after a few months. Therefore, it is necessary to follow a special diet for several weeks, and after that you can begin to eat as the patient is used to. Sometimes the attending physician may recommend some other diet, in which case it is better to listen to it.

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Peritonitis is a pathological condition characterized by inflammation of the thin connective tissue membrane (peritoneum) that covers the abdominal cavity from the inside.

In most cases, peritonitis occurs as a complication of various surgical pathologies of the abdominal cavity, accompanied by a violation of the integrity of the wall of the large (in 32% of cases) or small intestine (13% of cases), the appendix of the cecum (appendix) (3% of cases), stomach / duodenum intestines (18% of cases) with the expiration of the contents of the gastrointestinal tract into the abdominal cavity.

Classification of peritonitis

1. The following types of peritonitis are distinguished by the pathways of infection:
2. Primary: caused by the spread of infection through the blood (hematogenous) or lymph (lymphogenous) from distant foci of infection. An example is spontaneous bacterial peritonitis diagnosed in patients with liver cirrhosis /, or tuberculous peritonitis in patients with pulmonary tuberculosis;
3. Secondary: arises as a complication of acute surgical pathology, accompanied by perforation of the hollow organs of the abdominal cavity. The most common cause of secondary peritonitis is appendicitis (K35), perforated gastric ulcer (K25) or duodenal ulcer (K26), diverticulosis (K57), circulatory disorders in the branches of the splanchnic arteries (intestinal infarction, thrombosis of the mesenteric arteries) (K55.0) hernia of the abdomen (K46.0), intestinal obstruction caused by intussusception (K56.1) or volvulus (K56.2) of the intestine, acute pancreatitis (K85). Secondary peritonitis may be the result of a surgeon's mistake made during surgery on the abdominal cavity (failure of the sutures on the intestine, damage to the walls of hollow organs by negligence). Any penetrating or blunt wound of the abdominal cavity also leads to secondary peritonitis (rupture of the spleen, liver, internal bleeding, stab or gunshot wound);
4. Tertiary: diagnosed in patients with a weak immune system, who have a serious disease of other organs and systems (tuberculosis, HIV, AIDS).
5. Downstream classification:
6. Acute peritonitis;
7. Chronic peritonitis.
8. Depending on the presence of infection, there are:
9. Bacterial (microbial) peritonitis;
10. Aseptic / chemical peritonitis. Possible reasons aseptic peritonitis - chemicals (hydrochloric acid of gastric juice), blood, bile flowing into the abdominal cavity. Aseptic inflammation of the serous membrane of the abdominal cavity is possible in patients with systemic diseases of the connective tissue (rheumatoid arthritis, systemic lupus erythematosus).
11. Classification by the nature of the exudate:
12. Dry peritonitis (no exudate);

Exudative peritonitis:

Serous;

Fibrinous;

Purulent peritonitis;

Hemmoragic.

Classification by the prevalence of inflammation of the peritoneum:

Local (local) peritonitis (affecting one area of \u200b\u200bthe abdominal cavity);

Widespread / diffuse peritonitis (affecting 2-5 areas of the abdominal cavity);

Total (with the defeat of the entire peritoneum).

Causes of peritonitis

The immediate cause of peritonitis in the vast majority of cases is an infection that causes inflammation. Aseptic peritonitis associated with the outflow of sterile biological fluids into the abdominal cavity is considered as such only at the onset of the disease. After some time, infection inevitably occurs.

An example of true aseptic peritonitis is inflammation of the peritoneum in systemic diseases of the connective tissue, caused by an autoimmune process. In such cases, surgical treatment is usually not required.

In most cases, peritonitis is caused by gram-negative and gram-positive intestinal flora.

A specific infection can also cause peritonitis. Chlamydial (K67.0), gonococcal (K67.1), syphilitic (K67.2), tuberculous (K67.3) peritonitis are most often diagnosed. Chlamydial and gonococcal peritonitis is more typical for women, due to the presence of direct routes of infection from the pelvic organs into the abdominal cavity through the fallopian tubes.

Risk factors for peritonitis

The following pathological conditions and medical procedures increase the risk of peritonitis:

• Ascites, liver cirrhosis;
• Severe diseases of other organs and systems;
• Chronic pelvic inflammatory disease in women;
• Peritonitis in the past in the same patient;
• Operational and diagnostic interventions in the abdominal cavity;
• Peritoneal dialysis (a procedure used to cleanse the blood of toxins and poisons).

The mechanism of peritonitis

Let's consider the mechanism of peritonitis on the example of appendicitis (inflammation of the appendix of the cecum).

The peritoneum is a thin connective tissue lining the organs and walls of the abdominal cavity. It constantly produces a small amount of fluid that facilitates the sliding of internal organs, contains a large number of blood vessels and nerves. Normally, the peritoneum and abdominal cavity are sterile.

The cecum, like any other part of the large intestine, contains a huge number of bacteria in its lumen. Under normal conditions, this microflora performs useful functions, participating in digestion, synthesis of vitamins, and supports the immune system. However, when the same bacteria enter the sterile abdominal cavity, they begin to show their pathogenic properties, provoking inflammation and intoxication. The situation is complicated by the large area of \u200b\u200bthe peritoneum, through which the waste products of bacteria and toxins are absorbed.

In the first hours after the onset of appendicitis, inflammation of the appendix is \u200b\u200blimited by its walls. The pain that occurs during this period is caused by reactive irritation of the nerve endings located in the peritoneum, which covers the appendix from all sides. As the disease progresses, inflammation leads to edema and an increase in the permeability of the walls of the appendix (phlegmonous appendicitis). Peritonitis, which begins at this stage, invades the own peritoneum of the appendix, which provokes intense pain in the right iliac region. Surgical removal of the appendix at this stage prevents possible complications in the form of diffuse peritonitis with the transition of inflammation to other areas of the abdominal cavity.

Late seeking medical attention provokes gangrenous appendicitis, with necrosis and perforation of the wall of the appendix. The content of the cecum and transudate enters directly into the abdominal cavity, seeding it with intestinal flora. A change in body position provokes the flow of the infected transudate into the subhepatic region and other parts of the abdomen, which leads to the spread of infection. 24 hours after perforation of the appendix, we can talk about diffuse peritonitis, with paresis (paralysis) of the intestine.

The infectious process leads to the activation of the immune system, massive intoxication of the body and other complications. Without treatment, peritonitis leads to sepsis - blood poisoning, occurring with multiple organ failure, resulting in a fatal outcome.

The body's response to infection depends on the state of immunity and health of the patient, the aggressiveness of the infection, the volume of intestinal contents that have flowed into the abdominal cavity.

Stages of peritonitis

There are 3 successive stages of peritonitis:

1. Reactive stage: lasts the first day after the onset of pain and is characterized by severe symptoms.
2. Toxic stage: lasts the next 24-72 hours. It is accompanied by an increase in the intoxication of the body and a decrease in local symptoms - abdominal pain, tension of the abdominal wall (a period of imaginary well-being).
3. Terminal stage: severe subtotal or total peritonitis with massive intoxication, multiple organ failure, toxic shock and irreversible changes in the body.

Peritonitis in children

Peritonitis in childhood develops faster and is more aggressive than in adults. In newborns and infants, this pathology is fatal in 78% of cases. The situation is complicated by the child's lack of ability to tell in detail and show what worries him and where he hurts. The only signs of pathology in such patients are constant crying, refusal to breast, tension of the abdominal wall, heat, blood in the stool. The main cause of peritonitis in children is volvulus, intestinal intussusception, ischemic intestinal infarction.

Peritonitis in the elderly

In contrast to children, peritonitis in the elderly can be mild pain and symptomatic. Pain syndrome is present only in 50% of patients, muscle tension of the abdominal wall - only in 34%. The reason is the reduced reactivity of the body and age-related changes. Moreover, in older people with diabetes mellitus, peritonitis can be almost asymptomatic. Late seeking medical help due to the absence of characteristic symptoms causes high mortality in patients of this age group.

Peritonitis symptoms

• Severe sharp pains in the abdomen, positive symptoms of peritoneal irritation;
• Abdominal muscle tension ("board-like" belly);
• Nausea, without or with vomiting;
• Fever (in 80% of patients with peritonitis, a high temperature with chills is determined);
• Lack of appetite;
• Strong thirst (it is strictly forbidden to drink and feed the patient);
• Frequent loose stools or lack of stool / intestinal waste gases;
• Rare scanty urination;
• Severe weakness;
• Tachycardia;
• Sticky cold sweat;
• Lack of sounds of intestinal peristalsis.

Diagnosis of peritonitis

Instrumental research methods are used to diagnose the causes of peritonitis and differential diagnosis of diseases that give similar symptoms. Includes X-ray of the abdomen, ECG, ultrasound of the genitourinary system, liver and biliary tract, pancreas, esophagogastroduodenoscopy (EFGDS). In controversial cases, computed tomography with contrast is used.

The minimum required set of laboratory tests:

• Complete blood count with leukoformula to determine leukocytosis;
• A blood test for amylase (if acute pancreatitis is suspected);
• General urine analysis (exclusion of acute pyelonephritis, which gives similar symptoms);
• Microscopic and bacteriological analysis of the transudate obtained during surgery, with culture for antibiotic sensitivity;
• Blood tests for group and Rh factor;
• Blood clotting test (coagulogram, hemostasiogram);
• Blood tests for HIV, RW, hepatitis B and C;
• Biochemistry blood test.

Peritonitis treatment

The main method of treatment is surgical. The purpose of the surgery is to eliminate the causes that led to the inflammation of the peritoneum. With appendicitis, this is the removal of the appendix; with a perforated ulcer - removal of the ulcer or radical gastrectomy (resection of a part of the stomach); with volvulus, strangulated hernia, with ischemic necrosis of the intestine - removal of an unviable part of the organ. Operation for peritonitis is the only available treatment method that can save the patient's life.

After eliminating the direct source of infection, the abdominal cavity is sanitized - peritoneal lavage. During this procedure, antiseptic solutions are poured into the abdominal cavity, which are then evacuated through drains (tubes that drain fluid out).

Preparation for surgery for peritonitis

Preparation for surgical treatment of peritonitis is standard for any interventions on the abdominal cavity. It includes intensive antibiotic therapy, gastric and / or large intestine lavage, premedication (use of drugs that facilitate immersion in anesthesia and prevent complications of anesthesia), measures to stabilize the patient's condition before surgery.

Medicines and drugs for peritonitis

The basis of drug therapy for peritonitis is antibiotic therapy, the purpose of which is to eliminate the infection. Modern antibiotics from the group of fluoroquinolones, cephalosporins, penicillins are used (a specific drug is selected based on the results of a microbiological study or empirically).

Complications of peritonitis

Possible complications of peritonitis:

• Abdominal abscess formation;
• Intestinal obstruction;
• Adhesive disease;
• Acute thrombophlebitis / thrombosis of the hepatic portal vein;
• Liver abscesses;
• Intestinal fistula formation;
• Abdominal compression syndrome (abnormal increase in pressure in the abdominal cavity);
• Hospital-acquired infection.

Correct lifestyle during the recovery period after peritonitis

The consequences of peritonitis and complete recovery of the body last for several months. During this time, it is necessary to follow the recommendations of doctors: use a postoperative bandage that prevents the formation of a postoperative hernia, do not lift weights, adhere to a healthy and balanced diet, lead an active lifestyle with dosed physical activity (walking in the fresh air, walking, breathing exercises, gymnastics).

Food for peritonitis in the acute period is strictly prohibited (it is forbidden to take any food or liquid). In the early postoperative period, table number 0 is prescribed according to Pevzner - not strong meat broths, juices, jelly, jelly, fruit and berry decoctions. Meals are fractional, frequent, in small portions, 6-8 times a day. It is forbidden to eat rough, hard food.

Forecast for peritonitis

With timely medical care, the prognosis is favorable. The risk of death is less than 5%. Lack of adequate diagnosis and treatment provokes complications in the form of shock, sepsis, multiple organ failure (mortality reaches 50%). The patient's age less than 10 years old and more than 65 years old is also associated with a great risk to life.

Prevention of peritonitis

Primary prevention of peritonitis is impossible. Secondary prevention consists in the timely diagnosis and treatment of pathologies leading to an acute abdomen. In patients with ascites / cirrhosis of the liver, antibiotic therapy is used as the primary prevention of spontaneous bacterial peritonitis.

Content

When the appearance severe pain in the abdomen that does not go away for a long time, you should immediately seek help from a doctor. It is possible that these are the first symptoms of peritonitis, a disease of the abdominal cavity, which poses a serious danger to humans. In an advanced or severe case, the disease can even lead to death.

What is peritonitis

If you experience sudden abdominal pain, you should know exactly what peritonitis is and whether it is life-threatening. Local or diffuse inflammation of the thin wall of the peritoneum - peritonitis - is caused by a fungal or bacterial infection that can enter the cavity from the outside or from another part of the body. Inflammation of the peritoneum occurs as a result of organ trauma. The development of the disease causes a disruption in the activity of the human body due to severe intoxication.

When pathogenic microorganisms act on the surface of the peritoneum, the connective tissue is capable of producing special substances that stop the process. If the number of pathogenic agents is large, then the abdominal cavity is involved in inflammation - a disease arises. The danger of the disease is that the infection can quickly spread through the bloodstream to vital organs. A common cause of the disease is inflammation of appendicitis. Appendicular infiltration is the most serious purulent disease that often develops in children.

Viral peritonitis

Depending on the causes of the occurrence, inflammation of the abdominal cavity is divided into different types:

• traumatic;
• acute;
• serous;
• purulent;
• infectious and others.

Viral peritonitis - what is this disease? The disease is an inflammation of the abdominal cavity with infectious primary organ damage. The viral form of the disease promotes the penetration of the infection through the bloodstream. This type is rarely diagnosed, only in 1% of cases. The disease is clearly manifested in appearance the patient. The skin turns pale, there is a breakdown. Other symptoms:

• nausea;
• vomiting;
• obstruction (paresis) of the intestine;
• lack of feces;
• shallow breathing;
• a dark coating appears on the tongue.

Acute peritonitis

Acute peritonitis is a type of infection in the abdominal cavity. The disease is accompanied by local pronounced changes and functional general disorders organism. Perforation of different parts of the digestive tract, destructive appendicitis, and pathology of the small intestine prevail in the structure of the causes. The surgical route of infection is divided into a separate group: these are patients with postoperative complications and penetrating wounds. Acute peritonitis of the abdominal cavity has the following symptoms:

• severe abdominal pain;
• intestinal paresis;
• nausea;
• dehydration.
• absence of gases;
• dry tongue;
• tachycardia.

Chronic peritonitis

The manifestation of inflammation of the peritoneum in a chronic form is erased. The main causes of the disease are pathologies of the peritoneal organs and complications after surgery. As a rule, chronic peritonitis is a sluggish, but at the same time progressive disease that is life-threatening. The patient does not experience muscle tension, acute pain, and the disease can go unnoticed for a long time. In a child, the disease can occur as a complication of appendicitis. The following characteristic features of this form are distinguished:

• excessive sweating;
• recurrent abdominal pain;
• drastic weight loss;
• constipation.

Peritonitis - causes

The main classification of the disease includes primary and secondary forms. In the first form, the disease can be caused by microorganisms that have entered the peritoneum through the bloodstream from the infectious focus. At the same time, the integrity of the abdominal cavity is preserved. The secondary type of the disease is accompanied by rupture or damage to all abdominal layers as a result of penetrating abdominal trauma. If peritonitis is suspected by symptoms, the reasons may be as follows:

• inflammation of the pelvic organs;
• pancreatitis;
• rupture of the appendix (appendage of the cecum);
• diseases of the digestive tract;
• diverticulitis;
• perforation of the gallbladder;
• surgical operations in the abdominal cavity;
• in gynecology - genital infections;
• complications after abortion;
• cirrhosis of the liver;
• acute intestinal obstruction.

Peritonitis - symptoms

Inflammation of the peritoneum often begins with acute pain. The sensation is rapidly enhanced by movement or pressing on the affected organ. As a rule, the pain is sudden, and its intensity constantly melts. Other possible signs of peritonitis:

• lack of appetite;
• nausea;
• chills;
• vomiting;
• heat;
• bloating;
• mendel's symptom (stretching of smooth muscles);
• difficulty defecating;
• excessive tiredness.

Peritonitis treatment

In the event of an inflammatory process of the peritoneum, the necessary therapy should be carried out only in the hospital, otherwise negative consequences are possible (hemoperitoneum, or accumulation of blood, which can spread throughout the body). Treatment of peritonitis at the first stage involves taking antifungal drugs or using antibiotic injections. The course lasts 2 weeks. Pain relievers are used to relieve pain.

Some patients have trouble digesting food and will need to be fed through a tube that is inserted into the stomach through the nose or surgically. In some cases, multiple dangerous abscesses (cavities filled with pus) develop in the peritoneum, then an operation using an ultrasound scan will be required, which is often performed under local anesthesia.

Diet after peritonitis

After the surgical operation, the patient is fed by means of a probe - the introduction of a nutrient mixture. At the end of the rehabilitation period, the doctor can allow a full diet. The definition of diet depends on the underlying cause of the disease. Meals after peritonitis should be fractional, frequent and include:

• slimy porridge;
• pureed products;
• lean meats;
• dairy products;
• jelly;
• yesterday's bread;
• vegetables that do not contain coarse fiber;
• scrambled eggs.

The diet prohibits the use of:

• smoked, salted, pickled products;
• chocolate;
• tea, coffee.

Rehabilitation after peritonitis

In the postoperative period, problems may arise that are associated with normal bowel function, severe pain syndrome, and the development of purulent complications. So that such troubles do not arise, there was a favorable prognosis for recovery, rehabilitation after peritonitis is necessary, including:

• hourly assessment of the state of the pulse rate, respiration, diuresis, venous central pressure;
• constant monitoring of the patient,
• warming the patient to body temperature;
• infusion therapy with colloidal solutions;
• early restoration of intestinal peristalsis;
• ventilation of the lungs for 72 hours;
• the introduction of a glucose solution;
• prevention of pain syndrome.

Video: peritonitis in children

Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can diagnose and give recommendations for treatment, based on the individual characteristics of a particular patient.

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