Volume 2

The principles and practice of medicine / by Rustomjee Naserwanjee Khory.

  • Khory, Rustomjee Naserwanjee.
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of medicine / by Rustomjee Naserwanjee Khory. Source: Wellcome Collection.

    672/764 (page 660)
    general. It is often a sequel of one or more attacks of acute peri- tonitis, and chiefly of the local form ; and the chronic affectioa thus resulting sometimes merges into a general attack. Localised chronic peritonitis is a common result of continued irritation set up by some diseased condition of the abdominal viscera. Chronic peritonitis may also be referred to irritation due to accumulation of faeces, and to various morbid growths in the peritoneum, as tubercle and cancer. Thus chronic peritonitis is common in stru- mous children. It is also noticed during convalescence from fevers, and in those who are hereditarily predisposed to phthisis. It sometimes occurs as a result of repeated operations of paracentesis, and is occasionally associated with chronic Bright's disease and rheumatism. Morbid appearances. — These vary with the seat, nature, and extent of the inflammation, but adhesions and thickenings consti- tute the chief morbid conditions. The thickening is due to the development of the inflammatory products into a fibrous or connec- tive tissue supplied with new vessels. It varies from a line to an inch or more. It may spread round the abdominal organs, forming thick and firm capsules, and into the peritoneal folds. It often unites organs to each other, and also to the abdominal walls, or to the omentum or the mesentery. The inflammatory products also form effusions, which may be serous, sero-fibrinous, or puriform, and blood is often present. Circumscribed accumulations may open into the bowels or through the abdominal walls. In chronic peritonitis due to the presence of tubercles and other morbid for- mations, these are found in the peritoneum and the abdominal lymphatic glands. Such products may become caseous or creta- ceous. The presence of tubercles may be due to infection from the purulent infiltration. The adhesions and thickenings lead to displacements and loss of mobility of various organs. Compres- sion, constriction, intussusception and twisting of the bowTels are occasional results. The omentum may be greatly distorted and the mesentery much shortened. These adhesions and thickenings some- times prevent the escape of the contents. Symptoms.—These are general and local. The general symptoms depend upon the condition with which chronic peritonitis is asso- ciated. In the case of tuberculosis, chronic peritonitis is charac- terised by symptoms which will be described in a special chapter. The local symptoms are due to the presence of inflammatory pro- ducts ; to the effects of these products upon the various organs and structures, and to the pressure exercised upon tubes, vessels, &c. The onset may be insidious and gradual, or the condition may result from an acute attack of peritonitis. The symptoms due to