Surgery - Acute Abdomen and Peritonitis

Question 1

Peritonitis caused by perforation of the gastric and duodenal ulcer:

A) is exclusively chemical because the content of stomach and duodenum is sterile
B) initially chemical, but bacterial peritonitis develops within hours due to overinfection
C) bacterial origin from the beginning
D) caused by anaerobic pathogens

Answer 1

B) initially chemical, but bacterial peritonitis develops within hours due to overinfection

EXPLANATION
The secretion produced by the mucous membrane of a healthy and ulcerative stomach is highly acidic and therefore practically sterile. In the case of perforation of gastroduodenal peptic ulcers, the fluid entering into the free abdominal cavity causes a violent chemical reaction on the large surface of the peritoneum, resulting in knifelike epigastric pain and diffuse reaction of the abdominal wall. The latter manifests itself in abdominal hardening of the abdominal wall, called „défense musculaire”. The fluid that entered into the abdomen is quickly overinfected, while the secretion of the duodenum containing the bile and the pancreatic fluid is not sterile. On the other hand the lack of the the acid content of the stomach will be resulted in the free passing of the flora of the mouth and esophagus containing highly pathogenic bacterias. The resulting peritonitis and sepsis can only be prevented by immediate surgery. Surgery means by closing the ulcerative perforation opening, removing the abdominal fluid (“aspiration”), and rinsing the abdominal cavity several times.