急性弥漫性腹膜炎

　　⑴腹内脏器的急性穿孔与破裂：是急性弥漫性腹膜炎最常见的原因。空腔脏器穿孔往往因溃疡或坏疽性病变进展而突然发生，例如，消化性溃疡、急性胆囊炎、伤寒溃疡、胃或结肠癌、溃疡性结肠炎、溃疡性肠结核、阿米巴肠病、憩室炎等穿孔而导致急性弥漫性腹膜炎。

　　⑵腹内脏器急性感染的扩散：例如急性阑尾炎、胆囊炎、胰腺炎、憩室炎、女性生殖道上升性感染（如产褥热输卵管炎)等，可蔓延至腹膜引起急性弥漫性腹膜炎。

　　(Three) Acute intestinal obstruction: Intestinal intussusception, intussusception, incarcerated hernia, mesenteric vascular thrombosis or thrombosis, etc., can cause绞窄性肠梗阻 after causing intestinal wall injury, losing normal barrier function, intestinal bacteria can pass through the intestinal wall into the abdominal cavity, causing acute diffuse peritonitis.

　　(Four) Abdominal surgical conditions: When sharp objects or bullets penetrate the abdominal wall, they can pierce hollow organs or introduce external bacteria into the abdominal cavity. Abdominal injuries can sometimes cause organ rupture, leading to acute diffuse peritonitis. During abdominal surgery, bacteria from outside can be brought into the abdominal cavity due to poor disinfection; or due to inattention during surgery, local infection can spread, or the suture sites of the stomach, intestines, bile, and pancreas can leak. Sometimes, neglecting aseptic operation during abdominal puncture fluid drainage or peritoneal dialysis can also lead to the consequences of acute diffuse peritonitis.

　　Due to large-area abdominal infection, concurrent sepsis and bacteremia are most common

　　In the late stage of acute diffuse peritonitis, peripheral circulatory failure, renal or pulmonary function failure may occur, leading to death.

　　Due to different pathogenic causes, peritonitis can occur suddenly or gradually. For example: peritonitis caused by acute perforation of gastric and duodenal ulcers or rupture of hollow organs is often sudden, while peritonitis caused by acute appendicitis, etc., usually has symptoms of the primary disease first, followed by the gradual appearance of peritonitis signs.

　　The main clinical manifestations of acute peritonitis are peritoneal irritation symptoms such as (abdominal pain, tenderness, muscle tension, and rebound pain) in the early stage. In the later stage, due to infection and absorption of toxins, the main manifestations are systemic infection and intoxication symptoms.

　　(One) Abdominal pain

　　This is the main symptom of peritonitis. The degree of pain varies with the degree of inflammation. However, it is usually very severe, unbearable, and persistent. Pain can be exacerbated by deep breathing, coughing, or turning the body. Therefore, the patient does not change body positions and the pain usually starts from the primary focus. After the inflammation spreads, it extends to the entire abdomen, but is still more significant at the primary site of the disease.

　　(Two) Nausea and vomiting:

　　This is a common early symptom. Initially, it is caused by reflex nausea and vomiting due to the stimulation of the peritoneum, with the vomit containing stomach contents. In the later stage, when paralytic ileus occurs, the vomit turns into yellow-green bile-containing fluid, or even brownish fecal-like intestinal contents. Due to frequent vomiting, severe dehydration and electrolyte imbalance may occur.

　　(Three) Fever:

　　For peritonitis that suddenly develops, the body temperature may be normal at first, and then gradually rise. In elderly and weak patients, the body temperature may not necessarily rise with the severity of the disease. The pulse usually accelerates with the rise in body temperature. If the pulse quickens while the body temperature decreases, it is often a sign of deterioration of the condition, and effective measures must be taken as soon as possible.

　　For common diseases such as appendicitis, peptic ulcer of the stomach and duodenum, timely treatment should be sought if found.

　　Patients who have undergone abdominal surgery must keep the wound clean to prevent the overflow of gastrointestinal fluids and contamination of the abdominal cavity.

　　3. Avoid upper respiratory tract infection in daily life, and enhance physical fitness and improve the body's ability to resist diseases.

　　Percutaneous diagnostic puncture of the abdominal cavity plays a very important role, if purulent fluid is aspirated, or even droplets of fluid are observed under a high-power microscope to find a large number of white blood cells or pus cells, it can be diagnosed. If necessary, puncture can be performed at different parts of the abdominal cavity with a fine needle without anesthesia, and the aspirated fluid can better reflect the condition inside the abdominal cavity.

　　Acute diffuse peritonitis requires a low-salt, low-fat diet, eat less spicy foods, and can eat high-protein and high-vitamin foods.

　　Ginger porridge: 15 grams of ginger (crushed), placed in a bowl, add hot porridge, cover and stir for a moment, season with salt and eat.

　　Dahuang honey water: 15 grams of Dahuang, soaked in 200 milliliters of boiling water for 15 minutes, add appropriate amount of honey, drink as tea.

　　Traditional Chinese medicine dialectical treatment for acute diffuse peritonitis:

　　(One) Sudden closure of Qi and blood type

　　Main symptoms: Sudden and severe abdominal pain, as if cut with a knife, rapidly involving the entire abdomen; generalized abdominal tenderness, marked rebound tenderness, refusal to press, hard abdomen as a board, reduced or disappeared liver dullness. Accompanied by nausea and vomiting, constipation, and oliguria. The tongue is pale red, the coating is thin and white, the pulse is wiry and thin rapid.

　　Therapeutic method: Activate blood circulation and remove blood stasis, promote Qi and relieve pain.

　　Representative formula: Xuefu Zhuyu Decoction with modifications

　　(Two) Gastrointestinal real heat type

　　Main symptoms: Persistent severe abdominal pain, abdominal distension, refusal to press, local or generalized abdominal tenderness, rebound tenderness, marked abdominal muscle tension, decreased or absent bowel sounds, accompanied by fever, aversion to cold, nausea and vomiting, chest and abdominal fullness, constipation, and jaundice of urine. The tongue is red or deep red, the coating is yellow greasy or dry, the pulse is surging and rapid.

　　Therapeutic method: Open the interior and attack the bowels, relieve fire and detoxify.

　　Representative formula: Dachen Decoction combined with Huanglian Detoxification Decoction commonly used medicine

　　(Three) Collapse type

　　Main symptoms: Abdominal distension, generalized abdominal tenderness, rebound tenderness, marked abdominal muscle tension, lassitude or delirium, cold extremities, even cold limbs, shallow and rapid breathing, or presence of macules and epistaxis, hematemesis, hematochezia, dysuria, or even anuria. The tongue is shiny and deep red, the coating is yellow, dry, and thick, the pulse is deep, thin, rapid, or faint and almost extinct.

　　Therapeutic method: Clearing the nutrient-rich fluid, detoxifying, releasing heat, and nourishing Yin.

　　Representative formula: Qingwen Baihu Decoction combined with Qingying Decoction with modifications