1. Read the text and choose the sentences to answer the following

questions.

1. What infectious agents are responsible for the inflammation of peritoneum?

2. What are primary changes in peritoneum?

3. What do clinical manifestations depend on?

4. What is abdominal inflammation usually accompanied with?

5. Is there any difference between acute and chronic peritonitis?

1. Make questions to the following sentences, using the interroga­tive pronouns given in brackets.

   1. Initially the transparent and glistening peritoneum becomes dull, opaque, and injected. (What)

   2. Localization of the process with abscess formation is a common sequal. (Why)

   3. In the acute case, the patient is prostrated by severe constant pain.

(When )

4. The patient lies quietly with shallow respiration and tends to draw up his thighs. (Why)

5. Fibrous adhesions may cause intestinal obstruction. (When)

3. Discribe the clinical features of peritonitis.

4. Give a short summary of the text.

Intestinal obstruction

The causes are mechanical, vascular, or neurogenic. Mechnical causes include bands and adhesions; incarceration of a loop of bowel in a hernia ring; pressure on the gut from adjacent tumours; impacted foreign body or feces, enteroliths, ascarides, or gallstones; primary and secondary neo­plasms of the bowel wall; inflammatory strictures; vascular causes are embolism or thrombosis of a splanchnic artery or vein with infarction of a bowel segment. The neurogenic group consists of paralytic ileus occur­ring after operations, or with peritonitis, violent pain, or severe disease of other organs.

Complete technical obstruction of the small intestine causes severe intermittent cramplike periumbilical pain. Vomiting soon follows; the higher the obstruction, the sooner the vomiting. Initially, vomiting coin­cides with pain but later occurs irregularly and becomes fecal in charac­ter. Abdominal distention is minimal if the obstruction is high but is con­spicuous if it is low in the small bowel. Peristaltic sounds are present and accentuated during colicky pains.

Symptoms of complete obstruction of the colon often are insidious in onset. Abdominal distention develops slowly, vomiting is infrequent and pain may be less severe than in small bowel obstruction. Partial obstruc­tion of the colon is manifested by intermittent cramps in the lower abdomen and constipation sometimes alternating with diarrhea.

Strangulation or infarction of the bowel caused by hernia, volvulus, intussusception, or vascular occlusion usually gives symptoms of com­plete intestinal obstruction. Initially the features of mechanical obstruc­tion predominate, but gradually are replaced by signs of paralytic ileus. Because local anoxia has damaged the bowel wall, shock, peritonitis, tox­icity and increasing leukocytosis are frequent. Stools containing occult or fresh blood sometimes occur during the early stages of mesenteric valvular occlusion.