1) Peritoneal syndrome is a general systemic disease beginning with inflammation of the peritoneum, disrupting homeostasis and organ function. 2) It has multiple potential causes and progresses through reactive, toxic, and terminal stages with worsening symptoms and mortality reaching 98-100% in the terminal stage if left untreated. 3) Urgent hospitalization and surgery are required for acute peritonitis to treat the underlying condition like a perforated ulcer or intestine before symptoms worsen.

1. PERITONEAL
SYNDROME
Dr. Elmadana

2. PERITONEAL SYNDROME -
general systems disease of body, beginning in result of
inflammatory of peritoneum with difficult of violation
in homeostasis, in exchange process of organism,
with development of polyorgan of insufficient

3. ACTUAL OF PROBLEM
А) Polyetiology beginning of peritonitis be formed
difficult of diagnostic
B) Quick development of difficult pathological
of violation in body
В) High of mortality
- in reactive stage - 4–10%
- in toxic stage – to 40%
- in terminal stage – 98–100%

4. Beginning
of peritoneal syndrome
requirement of urgent hospitalization
in surgical division
for
u r g e n t operation

5. REASONS OF PERITONEAL
SYNDROME -
Perforate of ulcer stomach or duodenum
Perforate of small or large intestine
Inflammatory and destruction of process
in organs of abdominal cavity
and traumas this organs

6. Function of peritoneum:
Integument on organs of abdominal cavity
Resorbtion
Transudation
Plastic
Protect

7. Clinical symptoms of acute peritonitis
dependent from :
- area of microbes contamination of peritoneum
- virulent of microbes
- stage of process
- reactive force of patient
(including - gender, age, other
diseases)

8. Stages of acute peritonitis:
reactive 12 – 24 hours
toxic 2 – 3 days
terminal – more 3 days

9. - Active of symptoms of basis disease
- Including in inflammatory process of peritoneum
- Beginning of symptoms of intoxication
- Tension of reactive force of body
REACTIVE STAGE OF
ACUTE PERITONITIS:

10. REACTIVE STAGE OF
ACUTE PERITONITIS:
- Intensive permanent of pain in abdomen,
more active in place of inflammation
- Nausea, repetition of vomiting, weakness
COMPLAINS:

11. REACTIVE STAGE OF
ACUTE PERITONITIS:
ANAMNESIS OF DISEASE:
Connection with basis of disease,
traumas and operation

12. REACTIVE STAGE OF
ACUTE PERITONITIS:
OBJECTIVE DATA:
- Condition medium difficult
- Skin of white
- Temperature of body more 38С, tachycardia
- Breath of frequent, type of chest
- Position in bed of compel
- Tongue of dry
- Abdomen of symmetrical, part with place of inflammation lag behind
in breath
- In palpation anterior side of abdomen of tension and sharp of pain in
place of inflammation
- Sharp of positive of pathological symptoms of basis disease
(appendicitis, cholecystitis, pancreatitis and other)
- Local - symptoms of irritation of peritoneum
- In percussion obtuse in down places
- In auscultation – reduction of sound of peristaltic
- Per rectum – to hang over and pain of anterior side of rectum

13. - The symptoms of basis disease of “wipe off”
- Including in inflammation all peritoneum
-Intoxication (microbes toxins, autocatalytic ferments,
biogenic amines, metabolic toxins and other)
- Hypoxia
- Polyorgans insufficient (different of stages active)
- Violation of homeostasis
- Violation of exchange of substances
- Of dynamical intestinal obstruction
- Oppression of reactive forces of body
TOXIC STAGE OF
ACUTE PERITONITIS:

14. TOXIC STAGE OF
ACUTE PERITONITIS:
-Intensive permanent non-localization
of pain in abdomen
- Nausea, repetition of vomiting
(frequent of intestinal contents)
-Sharp of weakness, fever, fit of shivering
- Not leave of gas and stool
COMPLAINS:

15. ANAMNESIS OF DISEASE:
TOXIC STAGE OG
ACUTE PERITONITIS:
Long of time from basis
acute disease
(from 48 to 72 hours,
5 – 7 days after operation)

16. OBJECTIVE DATA:
- Difficult general of condition
- Face of “edge”, skin of white and grey, dry
- Breathless
- Arterial pressure less 100 mm. mercury columns , pulse more 100
blow/min
- Tongue of dry, cracking
- Abdomen puff up, in breath not particularly, moderate of tension
and pain in all places
- Symptoms of basis disease not manifestation,
domination of symptoms of irritation of peritoneum
- Percussion: in down places obtuse of sound
- Auscultation: peristaltic not sound
- Per rectum: to hang over, rigid and sharp pain
in anterior side of rectum
- Oligoanuria (through catheter in bladder of urinal)
TOXIC STAGE OF
ACUTE PERITINOTIS:

17. TERMINAL STAGE OF
ACUTE PERITONITIS:
Activation of developing in toxic stage
of pathogenic factors
Deep oppression of function of important for live
(central of nervous system,
cardio-vessels system,
breath system, evacuation system,
neuro-humoral system)

18. COMPLAINS:
gather of difficult or impossible
from tangled of consciousness
and not adequate of patient
TERMINAL STAGE OF
ACUTE PERITONITIS:

19. ANAMNESIS OF DISEASE:
Long of time after
acute beginning of basis disease
before 5 – 7 days
TERMINAL STAGE OF
ACUTE PERITONOTIS:

20. OBJECTIVE DATA:
- Condition of very difficult or terminal
- Consciousness of tangled, delirium, toxic coma
- Skin of white and grey, dry, acrocyanosis
- Face of “edge”, eyes of come down (facieses Hippocratic)
- Arterial pressure less 60 mm.mercury columns,
pulse 120 blow/min, arrhythmia, absence of pulse
on radiant of arteries
- Breath of frequent, of superficial or with elements of pathological breath
- Frequent vomiting of stink of intestinal contents
- Tongue of dry, cracking
- Abdomen of broad, weak of pain and tension cross to
not pain and soft
- Weak of active of symptoms irritation of peritoneum or absence
- Percussion: obtuse of sound in all parts of abdomen
- Auscultation: peristaltic not sound, sound of water waves
- Anuria
- Absence stool and gas
TERMINAL STAGE OF
ACUTE PERITONITIS:

21. DIAGNOSTIC PROGRAM FOR PATIENTS
WITH PERITONEAL SYNDROME:
Clinical symptoms
а) complains
b) anamnesis disease and vitae
c) objective data
Laboratory research
а) analysis of blood (leucocytosis with formula in left
to junior forms, toxic of grain in leucocytes)
b) analysis of urine (protein, erythrocytes,
cylinders), diastase of urine more N
c) glucose of blood more N

22. METHODS APPARATUS AND
INSTRUMENTAL RESEARCH:
а) visual X-ray graphic for organs abdominal
cavity for reveal symptoms of mechanical
or dynamical intestinal obstruction
and reveal выпота в плевральной полости,
преимущественно слева
б) сонография (для оценки состояния поджелудочной
железы и парапанкреатической клетчатки, наличия
жидкости в брюшной полости, состояния жёлчного
пузыря и внепечёночных жёлчных протоков)
в) лапароскопия диагностическая
(может применяться для уточнения диагноза
и причины перитонита)

23. USING OPERATION
BEFORE 6 HOURS -
M O R T A L I T Y
USING OPERATION
AFTER 12 - 24 HOURS -
M O R T A L I T Y
Operations:
radical and palliative
Results of surgical treatment dependent
from time with beginning perforate ulcer
to operation

24. USING
PALLIATIVE OF
OPERATION
DEMAND OF
APPLICATION OF
COMLEX OF ANTIUCLER
THERAPY