Editing Peritonitis (section)

== '''Pathophysiology''' ==

* '''Primary peritonitis:''' originates from a source outside the abdomen, including dialysis catheters
** Extremely rare without a known predisposing factor
** Typically single organism
*** ''Streptococcus'' through genital tract in young girls
*** ''E coli'' in spontaneous bacterial peritonitis affective pre-existing ascites from cirrhosis
*** ''Staphylococcus'' through a peritoneal dialysis catheter
** Seen on presentation as an acute abdomen with free fluid on CT but no obvious source
** Diagnosis via paracentesis (polymorphonuclear count in ascitic fluid > 250 cells per cubic mm
** Avoid diagnostic exploratory laparoscopy or laparotomy because of its prohibitive mortality
* '''Secondary peritonitis:''' caused by a breach in the anatomical integrity of a hollow viscus
** Usually aerobic and anaerobic polymicrobial inoculation, reflecting GIT flora
* '''Tertiary peritonitis''': the end stage of high-risk intra-abdominal infection
** Becoming less-frequently described and less useful as a clinical descriptor
** Seen in an ICU patient with multi-organ dysfunction, who has survived peritonitis through aggressive source control but has an open abdomen, and now the peritoneal cavity contains a thin, cloudy, poorly walled-off exudate which grows opportunistic micro-organisms
** An outcome of unsuccessful treatment of bacterial peritonitis
** Frequently fatal outcomes