[etiology]
(1) The digestive tract is perforated and the contents of the digestive tract leak into the abdominal cavity.
(2) Bladder rupture, such as urethral obstruction, bladder stones, bladder puncture, etc.
(3) perforation and rupture of reproductive system, uterine empyema, dystocia rupture, etc.
(4) Abdominal wall penetrating injury, abdominal wall contusion, infection after abdominal operation, and stimulation of disinfectant during operation.
(5) Secondary inflammation of abdominal organs.
【 Symptoms 】 Acute peritonitis, severe abdominal pain, abdominal wall tension and abdominal distension. Abdominal palpation resistance, depression, chest breathing, elevated body temperature, loss of appetite and sometimes vomiting.
When peritonitis oozes obviously, the abdomen may swell due to effusion, leading to dehydration, emaciation and anemia. Severe exudative peritonitis can cause internal organs to adhere to each other, affecting gastrointestinal peristalsis and normal physiological functions of other abdominal organs. Adhesive peritonitis often has a poor prognosis.
Blood test: the total number of white blood cells increased greatly, neutrophils increased, and the nucleus moved to the left. Abdominal puncture showed that the protein content was above 4%, the color was cloudy, the specific gravity increased (above 1.05438+08), and the number of white blood cells reached above 20000 /m3. The smear examination showed that bacteria appeared.
[therapy]
(1) Abdominal cavity blocking therapy: firstly, the ascites in the abdominal cavity is discharged, and after the liquid is discharged, penicillin 50000 units /kg body weight, streptomycin elbow-10000 units /kg body weight, elbow% procaine and elbow milliliter /kg body weight are injected intraperitoneally. Mixed and injected intraperitoneally.
(2) Control infection, replenish energy and relieve acidosis. Glucose saline 100- 1000 ml, dexamethasone 2- 10 mg mixed intravenous drip, after the above liquid drops, intravenous injection of 5% sodium bicarbonate injection 5-50 ml.
(3) For suppurative peritonitis, peritoneal lavage with mixed penicillin saline can be performed. 2 days/time.
(4) Systemic treatment, which should be given to dogs with dietary difficulties; Dogs with acidosis were treated with alkali supplementation; Fluid replacement therapy for dehydrated dogs. The specific usage can be 20- 100% of 25% glucose injection,100 ml of 5% sodium bicarbonate injection, 200-500 ml of normal saline or compound normal saline, and intravenous drip 1-2 times a day until dogs can feed themselves.
(5) Strengthen nursing and put the sick dog in a dark kennel to prevent the sound from scaring. Massage the dog's body with a brush to promote blood circulation and prevent falls and bedsores.
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Peritonitis is not serious or the diagnosis is not clear. Usually there is not much fluid in the abdominal cavity, and abdominal distension is not obvious. At this time, conservative drug treatment can be carried out, symptoms can be observed, and a series of examinations can be carried out. Then, according to the examination results and the development of the disease course, decide whether to perform surgical treatment.
When the symptoms are not relieved, but aggravated, surgery must be performed, such as abdominal organ rupture, intestinal necrosis caused by inflammation, intestinal perforation, gallbladder gangrene perforation, appendicitis perforation, gastric and duodenal perforation, etc.
1, medical
A. Bed rest: When the patient has no symptoms of shock at the initial stage, he should take a semi-sitting and lying position. The liquid in the abdominal cavity will be concentrated in the lower abdomen due to sitting and lying, which is beneficial to drainage. At the same time, get out of bed often to avoid another complication, such as bedsore and venous thrombosis of lower limbs.
B. Fasting: If the patient suffers from gastrointestinal perforation, he/she must fast to reduce the contents of the patient's gastrointestinal tract.
C. Gastrointestinal decompression: The purpose of inserting nasogastric tube is to relieve flatulence and relieve gastrointestinal decompression.
D. Intravenous injection: The purpose of intravenous drip is to replenish blood volume, maintain water-electrolyte balance, maintain acid-base balance, improve blood circulation, and avoid imbalance between body fluids and electrolytes on an empty stomach.
E. Drug treatment: After blood test and bacterial culture, the doctor will give broad-spectrum antibiotics intravenously first, and then adjust the drugs according to the results of blood bacterial culture.
When the above treatment methods can't control abdominal infection and eliminate abdominal effusion, doctors will take surgical treatment.
2. Surgical treatment
The purpose of the operation is to define the focus, control the infection and drain the effusion.
A. Surgical methods: Surgeons will perform exploratory laparotomy to remove or repair inflamed or perforated organs.
Appendectomy: If appendicitis is found during exploratory laparotomy, excision is feasible.
Colonectomy: When the tumor causes diverticulum perforation or colon perforation, colectomy and colostomy must be performed.
Cleaning the abdominal cavity: if the abdominal cavity is seriously polluted by a large amount of bile and gastrointestinal contents, or before suture after resection of the lesion, the surgeon will wash the abdominal cavity with sterile antibiotic solution or physiological saline solution. When cleaning, suction will be performed until the doctor thinks it is clean.
Drainage: The purpose is to discharge exudate from abdominal cavity through drainage tube, so as to control abdominal inflammation and prevent abdominal abscess.
Encyclopedia of medicine
postoperative care
Because of the potential multi-organ complications in patients with peritonitis, the medical staff will intensively monitor the patient's vital signs, consciousness, respiratory state (respiratory frequency and breath sounds) and body fluid electrolyte state (whether the output is balanced or not) at the initial stage.
Due to the different scope and types of abdominal surgery, the wound size will be different. The following are matters needing attention after abdominal surgery for your reference in nursing. If there is any deficiency, please follow the health education given by the medical staff who operated on you.
1. posture:
You can take a semi-supine position (that is, 45 ~ 60 degrees), which can promote breathing and help drainage, because the contents in the abdominal cavity compress the diaphragm and affect the respiratory muscles.
Nasogastric tube indwelling:
The slow peristalsis of intestine after operation may cause flatulence, so a nasogastric tube may be placed, which can drain the liquid and gas in the body, so it is necessary to do a good job of fixation; If it falls off or slips out, you must inform the medical staff to deal with it, because you may accidentally insert the catheter into the trachea and cause tracheal injury. Never insert it back yourself!
Drainage tube indwelling:
When draining the liquid and blood in the abdominal cavity, please pay attention to whether the drainage tube is folded, twisted or blocked. If you feel that the tube is not smooth, unable to flow out or blocked, and the wound has been oozing blood, please ask the medical staff to deal with it immediately.
Oral hygiene:
Because patients must fast after surgery, they often feel thirsty when body fluids are lost. At this time, clean water or lemonade can be used to help the mucosa moist and avoid dry lips.
Diet and nutrition:
Absolute fasting after peritonitis surgery. The timing of eating and the choice of food depend on the type of operation. Generally, you can't eat until you restore intestinal peristalsis (or exhaust) and get the doctor's consent. I suggest you drink some boiled water first. If it doesn't choke or feel uncomfortable, you can start eating some liquid and light diets, and then you can take a few meals.
The problem of wound pain:
When the wound hurts unbearable, the medical staff will give you painkillers. If you want to exercise, you can press the wound moderately with your palm, or buy a suitable corset to relieve the pain caused by exercise (you can also use this method when coughing). In addition, if the situation permits and the doctor agrees, I suggest you get out of bed as soon as possible, because this can reduce the discomfort and pain caused by flatulence.