Sandbox:peritonitis

# Definition
Peritonitis defined as the inflammation of the peritoneum from any cause which lines abdominal cavity and the internal organs as a serosal  membrane. Contrast to peritonitis, Intrabdominal infection is defined as the inflammation of peritoneum due to infectious cause.

## Primary or Spontaneous Peritonitis
Primary peritonitis is defined as the infection of the peritoneal cavity which is spontaneous and often associated with liver disease and ascites. It is also known as spontaneous bacterial peritonitis. Primary peritonitis lacks an identifiable anatomical derangement.

## Secondary Peritonitis
Secondary peritonitis is defined as the infection of the peritoneum due to spillage of organisms into the peritoneal cavity resulting from hollow viscus perforation, anastomotic leak, ischemic necrosis, or other injuries of the gastrointestinal tract.

## Tertiary Peritonitis
Tertiary peritonitis is defined as the persistant or recurrent intra-abdominal infection that occur in 48 hours following the successful and adequate surgical source control of primary or secondary peritonitis.

## Bacterascitis
Bacterascites is defined as the presence of culture positivity without increase in PMN count in the ascitic fluid.

# Historical Perspective
The first reports describing this entity appeared in the German and French literatures between 1907 and 1958.
Spontaneous bacterial peritonitis was first described by Krencker in 1907 followed by Caroli in 1958 and Kerr and colleagues in 1963. The term 'spontaneous bacterial peritonitis' was coined by Conn in 1964 to depict a syndrome of peritonitis and bacteremia in Laennecs cirrhosis without an apparent cause of infection.

# Classification
Peritonitis is classified based on the etiology as follows:

# 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.

# Causes

## Common Causes

# Epidemiology
SBP is the most frequent bacterial infection in cirrhosis, accounting for 10-30% of all reported bacterial infections in hospitalised patients.
The prevalence of SBP in outpatient setting asymptomatically is low (< 3.5% ), but the prevalence increases to 8%-36% in the nosocomial setting.
Mortality rate for the first episode of SBP in in-patient setting varies between 10-50%, depending upon the risk factors. One-year mortality after a first episode of SBP has been reported to be 31% and 93%.

# 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.

# Treatment

## Primary Peritonitis
The flora of primary peritonitis is typically monomicrobial.

## Secondary Peritonitis
Treatment of secondary peritonitis depends on the etiological factor and effective therapy includes cause specific surgical intervention and adjunctive antibiotic therapy.

# Prevention
Prophylaxis is of crucial relevance when trying to improve survival.