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Old 03-24-2010
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Arrow Dealing with Peritonitis Questions

You are most likely going to see a case of peritonitis in your CK exam. The three most commonly tested varieties are the following three:

Acute abdomen (Gardern-variety) Secondary Peritonitis
This is usually due to a rupture of an intraperitoneal organ such as the appendix or the gall bladder. Patient presents toxic with acute sudden pain, shallow breathing, rigidity and rebound tenderness. Some critical vitals may also be seen.
The organisms are usually mixed enteric bacteria.
Treatment is emergency surgical laporatomy

Primary Peritonitis (AKA Spontaneous Bacterial Peritonitis)
Any patient with ascitis is vulnerable but specially nephrotic children and cirrhotic adults. Usually a single enteric Gram negative organism is the culprit.
The picture is less toxic than the garden variety.
Treatment is antibiotics and no need for surgery.

Peritoneal Dialysis Peritonitis
The peritoneal catheter is the portal of entry of the bug and therefore it's usually a Gram positive bacteria such as Staph aureus or Strept. The dialysate will come out cloudy.
Treat with antibiotics given through the same peritoneal catheter and no need for systemic antibiotics unless the patient is toxic. Make sure to cover for Gram positive antibiotics. No need to remove the catheter unless the patient did not improve on antibiotics.
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