Peritonitis

The peritonitis is the Inflammation Péritoine. The peritonitis is a serious Infection which can lead to death if it is not treated, because surface péritonéale is higher than body surface; the local and general consequences are thus very fast.

The infection comes from a suppuration or a perforation of the digestive tract making it possible bacteria to reach the peritoneum. According to the average buildings and generals of defense, three evolutions are possible: cure, the Abscess, or peritonitis.

The acute syndrome péritonéal

Functional signs

  • abdominal Pain of brutal installation, whose seat is function of the cause. In certain cases one can observe an irradiation scapular (pain projected in the area of the scapula), but generally this pain does not irradiate. Very intense, severe pain, continuous and exacerbated by all the movements.

  • Vomiting S frequent.
  • Stop of the inconstant transit….

General signs

  • Fever > 38,5 °C, function of the cause and the seniority of the peritonitis.

  • Increase in the Pulse, blood Pressure normal or low.
  • Deterioration of the general state.

Physical signs

  • inspection : the patient is pale and solidified, with a facies péritonéal, it is constantly thirsty and one does not observe a abdominal Respiration.

  • palpation : the Master symptom of the peritonitis is the abdominal Contracture which is an involuntary demonstration of the abdominal wall making it rigid (wood belly), tonic thanks to the musculature abdominal, permanent, invincible and painful; but it is an inconstant sign, the Défense péritonéale being more frequent.
  • sounding : abolition of the normal intestinal noises.
  • percussion : Matité or Tympanisme.
  • pelvic touches : sharp and exquisite pain of the Cul-de-sac Douglas.

Examinations

  • biology : Hyperleucocytosis and signs of Hémoconcentration.

  • Radiography : on a stereotype abdomen without preparation (if possible in position upright or sitted, at worst in décubitus side, the patient being lengthened on the side) one will be able to observe the existence of épanchement aérique or Pneumopéritoine characterized by the presence of air under the diaphragmatic cupolas. One will be able to sometimes also see the existence of a occlusive Syndrome paralytic characterized by a hydroaeric distension of the whole of the digestive tract and/or liquid levels in the digestive handles (horizontal images rectilinear, witness of the interface liquid-air and which are not visualized at the healthy subject because of the permanent mixing of the contents of the intestine).
  • echography - scanner : not indicated for the diagnosis of the peritonites but which can bring information as for their cause.

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