Acute suppurative diffuse peritonitis

　　Caused by the lesion of abdominal internal organs. For example, perforation and rupture of hollow organs, inflammation of appendix, gallbladder, female reproductive organs, and other inflammation directly spreading, intestinal necrosis, abdominal penetrating injury, iatrogenic abdominal operation, etc.

　　Acute suppurative peritonitis is a mixed infection of multiple species, especially aerobic and anaerobic bacteria mixed infections are more common, and Escherichia coli, Enterococcus, Pseudomonas aeruginosa, Clostridium perfringens, and other anaerobic bacteria are common.

　　Acute suppurative diffuse peritonitis is prone to complications such as hypokalemia, shock, intestinal obstruction, pulmonary function failure, and adult respiratory distress syndrome.

　　1. Hypokalemia (hypokalemia) refers to serum potassium concentration less than 3.5 mmol/L. The main causes of hypokalemia can be the loss of total potassium in the body, known as potassium deficiency; or potassium transfer to intracellular or excessive body fluid dilution, while the total potassium in the body is not deficient. Severe hypokalemia can lead to serious complications, even life-threatening.

　　2. Shock (shock) is a clinical syndrome characterized by acute effective blood volume deficiency caused by various severe pathogenic factors, with clinical features of neuro-humoral factor imbalance and acute circulatory disorders.

　　3. Intestinal obstruction refers to the obstruction of the passage of intestinal contents, which is simply said to be the obstruction of the intestines. Here, the intestines usually refer to the small intestine (jejunum, ileum) and the colon (ascending colon, transverse colon, descending colon, sigmoid colon). Acute intestinal obstruction is one of the most common surgical acute abdominal conditions.

　　4. Pulmonary function failure can lead to serious respiratory dysfunction, causing normal respiration to be impossible at rest, leading to hypoxia or carbon dioxide retention, and causing a series of clinical syndromes of physiological and metabolic disorders.

　　5. Adult respiratory distress syndrome is a type of acute respiratory failure, characterized by acute respiratory distress and hypoxemia. The blood gas examination shows PAO2 < 8.0 KPA, which often occurs after severe trauma, major surgery, or critical internal and surgical diseases.

　　(One) Abdominal pain: The degree of pain varies with the degree of inflammation, but it is generally very severe and unbearable, and it is persistent. Deep breathing, coughing, and turning the body can exacerbate the pain, so the patient should not change positions. The pain usually starts from the primary focus, and after the inflammation spreads, it extends to the whole abdomen, but the primary lesion site is more significant.

　　(Two) Nausea and vomiting: At first, nausea and vomiting are caused by reflexes due to stimulation of the peritoneum, and the vomitus contains stomach contents. In the later stage, when paralytic ileus occurs, the vomitus turns into yellow-green bile-containing fluid, or even brownish fecal-like intestinal contents. Due to frequent vomiting, severe dehydration and electrolyte disturbance may occur.

　　(Three) Fever: Acute suppurative diffuse peritonitis occurs suddenly, and the body temperature can be normal at first, then gradually rise, and the pulse usually accelerates with the rise in body temperature. If the pulse accelerates while the body temperature decreases, it is mostly a sign of deterioration in the condition, and effective measures must be taken as soon as possible.

　　(4) Infection and intoxication: When acute suppurative diffuse peritonitis enters a severe stage, fever, profuse sweating, dry mouth, rapid pulse, shallow breathing, and other systemic toxic manifestations often occur. In the later stage, due to the absorption of a large amount of toxins, patients are in a state of indifference, emaciated appearance, sunken eye sockets, cyanotic lips, cold limbs, yellow and dry cracked tongue, dry skin, rapid breathing, weak pulse, and so on. If the condition continues to worsen, death may occur due to liver and kidney failure and respiratory and circulatory failure.

　　Since the vast majority of acute suppurative diffuse peritonitis is secondary, if the primary focus that causes acute suppurative diffuse peritonitis can be treated correctly in time, it can minimize the occurrence of acute suppurative diffuse peritonitis. For example, in the early stage of acute appendicitis or acute cholecystitis, the focus should be excised, early relief should be given to intestinal obstruction, and early repair should be done for gastrointestinal perforation, which can greatly reduce the chance of acute suppurative diffuse peritonitis. When performing gastrointestinal surgery, it should be done to the utmost to prevent the overflow of its contents and prevent leakage at the suture site of the gastrointestinal tract, in order to maximize the reduction or prevention of postoperative acute suppurative diffuse peritonitis.

　　1. Laboratory and X-ray examination: the white blood cell count generally has a significant increase, and it is common to see nuclear left shift. However, when the condition is severe or the body's response is low, due to a large number of white blood cells infiltrating the peritoneum, the white blood cell count is not high, only the proportion of neutrophils increases or toxic granules appear, and the same is true when the body is aging or the immune function is low. Abdominal X-ray examination shows general distension of the intestinal lumen and multiple small gas-liquid levels, etc., signs of ileus. When there is gastrointestinal perforation, most cases show free gas under the diaphragm (should be erect fluoroscopy). This is of great significance in diagnosis. For patients with weak physique or those who cannot stand fluoroscopy due to shock, lateral filming can also show whether there is free gas present.

　　2. Urine becomes concentrated due to dehydration, protein and casts may appear, and urine acetone may be positive.

　　3. Laboratory and auxiliary examinations: there is a significant increase in white blood cells, diagnostic peritoneal puncture can withdraw pus, B-ultrasound or CT can see peritoneal effusion, the intestines are often dilated and bloated, and multiple gas-liquid levels can be seen under X-ray when there is paralytic ileus.

　　What kind of food is good for acute suppurative diffuse peritonitis?

　　1. Patients with acute suppurative diffuse peritonitis need to fast, especially for those with peritonitis caused by gastrointestinal perforation, it is necessary to fast absolutely to reduce the continued leakage of gastrointestinal contents. Generally, patients can start to eat after the recovery of intestinal peristalsis (or flatus) and with the consent of the physician. It is recommended to drink some plain water first, if there is no choking or other discomfort, you can start to eat some liquid and light foods, such as congee, vegetable soup, lotus root starch, egg flower soup, noodles, etc.

　　2. In addition to liquid foods, it also includes congee, plain noodles, vegetarian noodles, vegetarian wontons, bread, biscuits (low in oil), and a small amount of minced soft vegetables, etc.

　　3. When the body recovers, eat more nutritious foods such as fish, lean meat, protein, tofu, etc.

　　What foods should be avoided for acute purulent diffuse peritonitis?

　　1. Avoid greasy foods to prevent an increase in bile secretion, which can worsen reflux and the condition.

　　2. Avoid cold and raw foods. Overeating cold and raw foods can lead to coldness in the chest and abdomen, blood and Qi stasis, vomiting of clear water or acid water, and increased stomach pain. Avoid drinking carbonated drinks, cola, and eating spicy刺激性 foods.

　　3. Avoid smoking, drinking, and spicy刺激性 foods.

　　4. Avoid moldy, fried, smoked, and salted foods.

　　5. Avoid hard, sticky, and indigestible foods.

　　(1)Clear the focus of infection, control the source of pollution:

　　Simple suture repair is used for those who do not need to remove the focus of infection to control infection and remove the source of pollution, such as iatrogenic perforation during colonoscopy and early traumatic gastrointestinal perforation or some duodenal perforation, which can be treated with simple suture repair without resection of the affected part; for infected foci such as purulent appendicitis, gallbladder perforation, and intestinal segment necrosis, surgical resection is the most basic principle of treatment.

　　(2)Reduce peritoneal contamination:

　　①Peritoneal debridement: The purpose of the surgery is to remove the polluted substances that are conducive to bacterial growth, thereby reducing residual infection and preventing abscess formation.

　　②Intraoperative peritoneal lavage: Experimental research and clinical observations have proven that lavaging the peritoneum with normal saline during surgery can improve the prognosis of acute purulent diffuse peritonitis. The amount of lavage should be at least 1000-2000ml above, generally lavaging until the aspirate is clear. Although some people believe that lavage during surgery may spread infection, another concern is that the lavage fluid may dilute the phagocytes and调理素or bacteria suspended in the peritoneal effusion, affecting phagocytosis, but most believe that mortality is proportional to the total number of bacteria in the peritoneum, and intraoperative peritoneal lavage can reduce the total number of bacteria in the peritoneum, thereby reducing peritoneal contamination and the formation of residual abscesses, and can reduce mortality.