Editing Peritonitis (section)

== '''Management''' ==

* '''Approach'''
** Risk classification: assess premorbid reserves, current physiological compromise and virulence of infection
** Adjunctive measures
** Source control
** Peritoneal toilet
* '''Risk classification'''
** High risk: hospital-acquired infections; post-operative infections; critically ill or immunocompromised
*** Needs tailored antibiotics
*** Source control can be very hard
*** Poor prognosis
** Low risk: community-acquired (perforated appendicitis or diverticulitis etc); not physiologically compromised; pre-morbidly healthy
*** Standard broad-spectrum antibiotics
*** Source control will be easy
*** Good prognosis
* '''Adjunctive measures'''
** Resuscitation
** Monitoring
** Antibiotics
*** Empirical is ok - don't need peritoneal cultures in patients with community-acquired, low-risk peritonitis; but should be obtained in the following situations:
**** High-risk peritonitis
**** Already been on antibiotics
**** Previous resistant organism
**** Suspected primary peritonitis
**** Tertiary peritonitis
* '''Source control'''
** Doesn't necessarily mean an operation - match the intervention to the individual patient
** Use the least invasive approach that can achieve source control
** Temporisation if there is major physiological compromise, but otherwise as soon as possible
* '''Peritoneal toilet''' (if operating)
** Remove liquid contaminants and infected exudates
** Irrigate with warm crystalloids
** Rationalise use of drains - evacuate established abscesses, allow escape of potential secretions, or establish a controlled intestinal fistula
* '''Recognise treatment failure'''
** Ongoing or increasing sepsis for more than 24-48 hours suggests that the initial source control was inadequate

[[Category:Critical care]]