Obstetrics and Gynecology - A.M. Gromova 2000

"Acute abdomen" in gynecology
Pelvioperitonitis and peritonitis
Peritonitis

Peritonitis is a severe surgical and gynecological condition that develops when an inflammatory process spreads across the entire Peritoneum of the Abdominal cavity, characterized by endogenous intoxication resulting from microcirculatory disorders and The Emergence of destructive Changes in the Kidneys, Liver, and Small Intestine.

The clinical course of peritonitis involves three phases: reactive, toxic, and terminal.

The reactive phase of peritonitis is characterized by preserved compensatory mechanisms. The patient's condition is relatively stable. There is an elevation in body Temperature accompanied by tachycardia that outpaces the thermal response. The abdomen is tender and rigid, with positive peritoneal signs. Mild intestinal paresis is present, with sluggish bowel sounds auscultated on examination. Blood tests reveal moderate leukocytosis, a left shift in the leukocyte formula, and an elevated ESR.

The toxic phase develops As a result of escalating intoxication. The patient complains of nausea, vomiting, eructation, and loose stools. Lethargy sets in. The Tongue is dry and coated. The abdomen is tender, does not participate in Respiration, remains rigid and distended, and bowel sounds are absent. Leukocytosis and the left shift of the leukocyte formula progress further.

The terminal stage of peritonitis is distinguished by the prominence of all the aforementioned symptoms alongside signs of Central Nervous system involvement. Patients are in a severe, lethargic state. The Skin is pale with a grayish tint, cold sweat appears, and facial features become sharp. ARTERIAL BLOOD PRESSURE is reduced. The pulse is rapid and arrhythmic. Marked dyspnea is observed. The intestines are atonic.

A Diagnosis of peritonitis serves as an absolute indication for surgical intervention. Preoperative preparation is carried out within two hours and includes gastric lavage, infusion therapy aimed at detoxification and stabilization of the patient's condition, and intravenous administration of Antibiotics.

The Scope of the surgical Procedure depends on the specific clinical situation. Mandatory steps include the elimination of the purulent focus and peritoneal lavage with 1:5000 furatsilin solution. Drainage of the abdominal cavity is established beneath the right and left domes of the Diaphragm as well as in both iliac regions.

The postoperative period involves intensive infusion and antibacterial therapy. Broad-spectrum antibiotics are prescribed, electrolyte and protein deficits are replenished, acid-base balance is corrected, and detoxifying agents are administered. One of the most crucial components of postoperative management is the restoration of the motor-evacuation function of the gastrointestinal tract.

Modern additions to postoperative peritonitis therapy include gravitational blood surgery techniques—extracorporeal hemosorption and plasmapheresis. Pathogenetically substantiated Methods also include ultraviolet blood irradiation and Hyperbaric Oxygenation.

Control Questions

1. What does METABOLISM/2.html">THE CONCEPT OF "acute abdomen" entail?

2. Which groups of diseases constitute the causes of an "acute abdomen"?

3. List the Clinical forms of Ectopic Pregnancy.

4. What surgical Procedures are performed in the Treatment of ectopic pregnancy?

5. What is Ovarian Apoplexy and what are its causes?

6. On The basis of what data is the Differential diagnosis between ectopic pregnancy and ovarian apoplexy conducted?

7. What treatment methods for ovarian apoplexy are you familiar with?

8. The technique for performing tubectomy and salpingotomy.

9. What constitutes the "anatomical" versus the "surgical" pedicle of an ovarian tumor?

10. What are the Specific features of surgical intervention for a twisted ovarian cyst pedicle?

11. On the basis of what findings is the diagnosis of Fibromatous node necrosis established?

12. What surgical interventions are performed in cases of fibromatous node necrosis?

13. Which Inflammatory Diseases cause an "acute abdomen" in gynecology?

14. In what cases is conservative management employed for purulent tubo-ovarian masses?

15. Describe the Clinical presentation of pelvic peritonitis.

16. List the Additional Diagnostic Methods indicated for Pelvioperitonitis.

17. Name the clinical phases of peritonitis.

18. State the core principles of postoperative management in pelvioperitonitis.