How does modern medicine respond to the question of what is peritonitis

Modern medicine gives its answer to the question of what is peritonitis. This disease, characterized by inflammation of the leaflets of the peritoneum, is presented in the form of stress, which is formed under the influence of several factors:

• Endogenous (infection, inflammation);
• Exogenous (anesthesia, operating injury);
• Depressive effect on the immunity of stress hormones (cortisol, adrenocorticotropic hormone) released into the blood.

In order to understand what peritonitis is and why it arises, it is necessary to recall all the organs covered by the peritoneum, since in inflammatory-destructive diseases of the abdominal cavity organs inflammation of the peritoneal sheets occurs in about 80% of cases. Most often these are local infectious and inflammatory processes of the abdominal part of the esophagus, different parts of the stomach, duodenum, small and large intestine, appendix, liver, pancreas, biliary tract, pelvic organs. A special group consists of peritonitis with closed injuries and wounds of the abdominal organs, and also developed as a result of postoperative complications (iatrogenic injuries of internal organs, anastomosis failure). The image below shows peritonitis (photo).

Scientists continue to study the problem of peritonitis, as the average mortality rates remain rather high (20-30%) and reach 40-50% in severe cases, for example, in postoperative peritonitis. Only by answering the question about what peritonitis is, can we find effective ways to eliminate this problem.

In 2000, VS Saveliev and a group of co-authors, in order to find an answer to the question of what peritonitis is, proposed a unified classification of these conditions according to the etiological principle. In accordance with it, three main categories of peritonitis are distinguished:

1. Primary peritonitis, which develops in the absence of damage to hollow organs as a result of spontaneous dribbling of blood in the abdominal veins or by the passage of a specific infection from another organ (eg, tuberculous peritonitis, spontaneous peritonitis). It is 1-5% of cases.
2. Secondary peritonitis. It occurs most often. It is represented by several varieties: postoperative, post-traumatic - in connection with destruction or perforation of the abdominal cavity organs. It develops as a local defensive reaction of the body to infection.
3. Tertiary peritonitis. The most severe form of diagnosis and treatment, which proceeds with the development of the so-called persistent or recurrent peritonitis. Develops after operations, injuries, extreme situations, accompanied by a pronounced suppression of the mechanisms of antimicrobial protection. In this case, the inflammation is caused by the microflora, which survived the first cycle of antibacterial treatment.

The features of the clinical course and the choice of therapeutic tactics are largely determined by the pathological contents of the abdominal cavity, on the basis of which a classification has been made with the following forms of peritonitis:

• Fecal;
• Bile;
• Hemorrhagic;
• Chemical.

According to the nature of the exudate, the following types are distinguished:

• Serous-fibrinous (serous) peritonitis;
• Fibrinous-purulent;
• purulent.

The study of peritonitis continues with the goal of developing a differentiated treatment strategy. The choice of classification principles is complicated by the fact that the inflammation of the peritoneal sheets is a multifactorial process. However, a classification is being developed that can reflect the severity of the general symptoms and formulate a reliable prognosis.