A Text-book of medical practice for practitioners and students / edited by William Bain.
- Date:
- 1904
Licence: In copyright
Credit: A Text-book of medical practice for practitioners and students / edited by William Bain. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
182/1042 page 154
![outwards—facies hippocratica. Vomiting ensues, sometimes followed by painful retching. Hiccough frequently occurs, and is an important sign in peritonitis. The bowels are usually constipated, but their condition depends on the cause of peritonitis. The physical signs which are present in general peritonitis in the abdomen present considerable variety. The typical signs may be said to be moderate distention of the abdomen and some general increase of resistance all over the abdomen, in the upper as well as the lower part. In some cases tympanites occur, especially towards the latter end of the case, and the great distention which ensues not only increases the pain, but causes embarrassment of the cardiac action. A moderate degree of fluid may be detected in the flanks, or sometimes only in the pelvis by rectal examination. There are some cases of acute peritonitis which are masked, the infection not being accompanied by much pain or by pyrexia and no definite physical signs are to be detected in the abdomen. In these cases, however, there is usually some sign or symptom pointing to the involvement of the peritoneum, such as the expression of the face and the occurrence of hiccough. The heart action is_ con- siderably embarrassed in general peritonitis, partly from the toxaemia which is present, but also from a reflex effect of the peritoneum on the cardio-inhibitory centre. ' The pulse is rapid, small and not infrequently wiry. It tends rapidly to fail and death occurs from cardiac failure as well as from the toxaemia. The respiration is frequently hurried and abdominal respiration not uncommonly ceases altogether. . ■ t When peritonitis occurs in the course of an acute disease such as enteric lever the symptoms may be masked. , j- The symptoms of peritoneal abscess are discussed under other headings. Diagnosis.—The diagnosis of acute general peritonitis is to be made by atten- tion to the physical signs and general symptoms already mentioned General peritonitis is sometimes diagnosed when one or other form.of tender abdomen is present. Diffuse tenderness of the abdomen or locaUsed tenderness m several parts is very common in neurasthenia, chronic alcohoUsm and m functional disorders of digestion, but none of these cases can be mistaken for peritonitis, ihe absence of fever, the absence of any sense of resistance in the abdomen exclude the presence of an infection. There is always in these cases, as weU, a long history of local tenderness in the abdomen with recurrent attacks. _ Treatment.—The treatment of acute peritonitis depends on its cause, ibis may be undiscoverable. If the case is due to perforation the only treatment hkely to be of service is surgical. Medical treatment is directed to the rehef of pam by the application of glycerine of belladonna and hot fomentations to the abdomen, changed every two hours, and by the administration of opmm mternaUy, or mor- phinl hypodermically for the relief of the pain. In some cases the admimstration of mercury is said to be beneficial. The patient is to be kept on a milk diet and mav have to be fed per rectum. , n , CHRONIC PERITONITIS.—Peritoneal adhesions have already been considered. There remains for discussion the chronic peritonitis due to tuberculosis and to cancer. Cancerous peritonitis has already been partly considered m dealing ^'it^i new growths in the gastro-intestinal tract to which it is secondary^ The signs are usul% shown by an increase of resistance in the abdomen and by the presence of ascites. TUBERCULOUS PERITONITIS. Tuberculous peritonitis is due to the deposit oi }ferc]^l^^ the vM visceral neritoneum, the great omentum bemg specially affected. It staits com Tonlv b? infeXn from the intestine. In some cases the intestine shows ulcera- to ^in others i? is not ulcerated; and in either of these conditions the mesenteric Ind 'coL dands may be enlarged and tuberculous, constituting the condition called ^l:test^irVseen.sSo..eyer, hardly worth while to retam this name,](https://iiif.wellcomecollection.org/image/b21510167_0182.jp2/full/800%2C/0/default.jpg)
