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Abstract: The case patient in this episode was a 60-year-old male. The patient presented with more severe abdominal pain and nausea that gradually worsened, so the patient was examined and liver function tests were performed, and the results showed cirrhosis and ascites complicated by primary peritonitis. After admission, the patient was treated with antibiotics to relieve primary peritonitis and liver-protective drugs to control cirrhosis. After systematic treatment, the clinical symptoms basically disappeared and ascites basically disappeared, and he was discharged successfully.
[Basic information] Male, 60 years old
Disease Type】Cirrhosis, ascites, primary peritonitis
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】December 2021
Treatment plan】Laparotomy + medication (ceftazidime + human albumin + hepatocyte growth promoter) + parenteral nutrition
Treatment period】Inpatient treatment for 14 days, regular review within 3 months after discharge
Treatment effect】The clinical symptoms basically disappeared, ascites basically disappeared, and the patient was discharged successfully.
I. Initial consultation
One day in December 2021, a pale patient came to the hospital. The patient reported that he had a sudden onset of stomach pain with nausea this morning, and after resting for a while, the symptoms of stomach pain became more obvious and the scope of pain gradually became larger. After preliminary examination, the patient showed positive signs of peritoneal irritation, and the abdominal CT examination showed cirrhosis of the liver and ascites, which excluded secondary peritonitis.
II. Treatment history
After the patient was admitted to the hospital, the patient was asked whether he had any allergic medications, and after confirming that he had no history of antibiotic allergy, he was given an infusion of ceftazidime to reduce the inflammatory response and relieve the symptoms of peritonitis. Since the patient had cirrhosis and ascites, he also required laparotomy to reduce ascites, human albumin to improve liver function and reduce ascites production, and intravenous hepatocyte growth stimulant to protect liver cells. During the treatment period, parenteral nutrition is also needed to replenish the patient’s energy consumption and promote physical recovery.
III. Treatment effect
After the patient was admitted to the hospital and underwent active symptomatic treatment, his condition gradually stabilized, and the symptoms of abdominal pain as well as nausea and vomiting gradually disappeared. After 14 days of hospitalization, the patient’s daily life was basically unaffected, and the abdominal CT examination results showed that ascites basically disappeared, and transaminases, bilirubin and albumin levels returned to normal, so he could be discharged normally. Before discharge, the patient was instructed to take the medication according to the standard, and the review results within 3 months after discharge showed no recurrence of primary peritonitis and slow progression of cirrhosis, and he was very satisfied with the treatment effect.
IV. Notes
We are truly happy that the patient was successfully discharged from the hospital and that the primary peritonitis has been cured. However, even after discharge from the hospital, patients need to pay attention to the consolidation period, take medications as prescribed by the doctor, and pay attention to whether they have any adverse reactions such as nausea and vomiting, and should seek medical attention when they occur. In terms of diet, patients need to eat foods rich in protein and vitamins, such as dairy products and animal liver, especially for patients with cirrhosis, they need to avoid eating raw and cold foods. In terms of life, avoid bad habits such as smoking and drinking, and it is recommended to quit smoking and drinking. If patients’ weight exceeds the normal standard, they also need to exercise properly to control their weight, but they need to avoid too strenuous exercise.
V. Personal insight
Most patients with primary peritonitis may attribute the cause to common gastrointestinal disorders such as accumulation of food when symptoms such as abdominal pain, nausea and vomiting occur, thus missing the best time for treatment. Therefore, if you experience discomfort, you should go to the hospital for examination as soon as possible to confirm the cause of the disease and treat it symptomatically. As in the case of the patient in this age and with a history of cirrhosis, one should be more alert to the occurrence of primary peritonitis and should go to the hospital for regular physical examinations and periodic rechecking of liver function and liver hardness measurement for early detection, diagnosis and treatment.