Sandbox:peritonitis

Definition

Peritonitis defined as the inflammation of the peritoneum from any cause.

Primary or Spontaneous Peritonitis

Primary peritonitis is defined as the presence of polymorphonuclear cells >250/mm3 in ascitic fluid in the absence of an intra-abdominal source of infection or malignancy.

Classification

Peritonitis is classified based on the etiology as follows:

Peritonitis

Primary peritonitis

Secondary peritonitis

Tertiary peritonitis

❑ Spontaneous peritonitis ❑ Peritonitis in patients with CAPD ❑ Tuberculous peritonitis

❑ Peritonitis without evidence for pathogens ❑ Peritonitis with fungi ❑ Peritonitis with low-grade pathogenic bacteria

Acute perforation peritonitis ❑ Gastrointestinal perforation ❑ Intestinal ischemia ❑ Pelviperitonitis and other forms

Postoperative peritonitis ❑ Anastomotic leak ❑ Accidental perforation and devascularization

Post-traumatic peritonitis ❑ After blunt abdominal trauma ❑ After penetrating abdominal trauma

Pathogenesis

Peritonitis can be regarded as the localized event after any trigger of inflammation similar to the systemic inflammatory response(SIRS).

Primary peritonitis

As the primary disease (e.g. cirrhosis) progresses, gram negative bacteria increase in numbers in the gut. Once bacteria reach a critical concentration in the gut lumen, they will translocate into the mesenteric lymphatic system because of the failure of the gut to contain bacteria and failure of the immune system to kill the virulent bacteria once they have escaped the gut result in bacteremia and endotoxinemia.

Secondary peritonitis develops perforation of intra abdominal organs when bacteria contaminate the peritoneum as a result of spillage from an intraabdominal viscus. The organisms found almost always constitute a mixed flora in which facultative gram-negative bacilli and anaerobes predominate, especially when the contaminating source is colonic.

Epidemiology

SBP is the most frequent bacterial infection in cirrhosis, accounting for 10-30% of all reported bacterial infections in hospitalised patients.

Diagnosis

Identification of risk factors and individualisation of timing and selection of prophylactic measures are the key to success without major development of resistant bacteria.

Prevention

Prophylaxis is of crucial relevance when trying to improve survival.