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ACUTE GENERAL PERITONITIS. (Inflammation of the Peritoneum)

Category: Digestive Organs

Causes. Primary; Occurs without any known preceding
disease, and is rare. Secondary; Occurs from injuries, extension from
inflamed nearby organs, such as appendicitis or infection from bacteria,
without any apparent lesion (disease of the bowel). Perforation causes
most of the attacks of peritonitis. Peritonitis may accompany acute
infections or accompany chronic nephritis, rheumatism, pleurisy,
tuberculosis and septicemia. Peritonitis occurs from perforation of the
bowel in typhoid fever also, and it frequently occurs after appendicitis
and sometimes after confinement.

Symptoms. This is often the history of one of the causes mentioned above,
followed in cases with perforation or septic disease by a chill or chilly
feeling and pain, varying at first, with the place where the inflammation
begins. The patient lies on his back, with the knees drawn up, and the
body bent so as to relax the muscles of the abdomen, which are often
rigidly contracted,--stiff at first on the side where the pain starts. The
pain may be absent. The abdomen becomes distended, tympanitic (caused by
gas). An early symptom is vomiting and it is often repeated. There is
constipation; occasionally diarrhea occurs. The temperature may rise
rapidly to 104 or 105 and then become lower; it is sometimes normal. The
pulse is frequent, small, wiry and beats 100 to 150 per minute; the
breathing is frequent and shallow. The tongue becomes red and dry and
cracked. Passing the urine frequently causes pain; sometimes there is
retention of urine. The face looks pinched, the eyes are sunken, the
expression is anxious, and the skin of the face is lead colored or livid.
Hiccoughs, muttering, delirium or stupor may be present.

Recovery, Prognosis, etc. The action of the heart becomes weak and
irregular, respiration is shallow, the temperature taken in the rectum is
high, the skin is cold, pale and livid, death occurs sometimes suddenly,
usually in three to five days; less often thirty-six to forty-eight hours;
or even after ten days. The results depend mainly upon the cause of the
inflammation, and the nature of the infection, infectious disease that
produces it, being usually very bad after puerperal sepsis (after
confinement), induced abortion, perforation of the bowel or stomach, or
rupture of an abscess.



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