Secondary Peritonitis

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Information ⬇

Pathogenesis: Secondary peritonitis develops when bacteria contaminate the peritoneum as a result of spillage from an intraabdominal viscus.
Microbiology: Infection almost always involves a mixed flora in which gram-negative bacilli and anaerobes predominate, especially when the contaminating source is colonic. The specific organisms depend on the flora present at the site of the initial process.
Clinical manifestations: Initial symptoms may be localized or vague and depend on the primary organ involved. Once infection has spread to the peritoneal cavity, pain increases; pts lie motionless, often with knees drawn up to avoid stretching the nerve fibers of the peritoneal cavity. Coughing or sneezing causes severe, sharp pain. There is marked voluntary and involuntary guarding of anterior abdominal musculature, tenderness (often with rebound), and fever.
Diagnosis: Although recovery of organisms from peritoneal fluid is easier in secondary than in primary peritonitis, radiographic studies to find the source of peritoneal contamination or immediate surgical intervention should usually be part of the initial diagnostic evaluation. Abdominal taps are done only to exclude hemoperitoneum in trauma cases.

Treatment: Secondary Peritonitis

Antibiotics aimed at the inciting flora—e.g., penicillin/β-lactamase inhibitor combinations or a combination of a fluoroquinolone or a third-generation cephalosporin plus metronidazole—should be administered early.
- - For critically ill pts in the ICU, imipenem (500 mg q6h IV) or drug combinations such as ampicillin plus metronidazole plus ciprofloxacin should be used.
- - Surgical intervention is often needed.

Outline ⬆

Section 7. Infectious Diseases

78. Infections Acquired in Health Care Facilities

79. Infections in the Immunocompromised Host

Infections in Cancer PTS

System-Specific Syndromes

Infections in Transplant Recipients

Immunizations in Immunosuppressed PTS

80. Infective Endocarditis

81. Intraabdominal Infections

Peritonitis

Intraabdominal Abscesses

82. Infectious Diarrheas

Noninflammatory Diarrhea

Inflammatory Diarrhea

83. Sexually Transmitted and Reproductive Tract Infections

Individual Pathogens

84. Infections of the Skin, Soft Tissues, Joints, and Bones

Skin and Soft Tissue Infections

85. Pneumococcal Infections

86. Staphylococcal Infections

Infections Caused by Coagulase-Negative Staphylococci

87. Streptococcal/Enterococcal Infections, Diphtheria, and Infections Caused by Other Corynebacteria and Related Species

88. Meningococcal and Listerial Infections

89. Infections Caused by Haemophilus, Bordetella, Moraxella, and HACEK Group Organisms

90. Diseases Caused by Gram-Negative Enteric Bacteria and Pseudomonas

91. Infections Caused by Miscellaneous Gram-Negative Bacilli

Cat-Scratch Disease (CSD)

92. Anaerobic Infections

93. Nocardiosis, Actinomycosis, and Whipple's Disease

Whipple's Disease

94. Tuberculosis and Other Mycobacterial Infections

95. Lyme Disease and Other Nonsyphilitic Spirochetal Infections

96. Rickettsial Diseases

97. Mycoplasma Pneumoniae, Legionella Species, and Chlamydia Pneumoniae

Introduction

Mycoplasma Pneumoniae

Legionella Species

Chlamydia Pneumoniae

98. Chlamydia Trachomatis and C. Psittaci

Introduction

Microbiology

C. Trachomatis Infections

C. Psittaci Infections

99. Herpesvirus Infections

100. Cytomegalovirus and Epstein-Barr Virus Infections

Cytomegalovirus

Diagnosis

Epstein-Barr Virus

101. Influenza and Other Viral Respiratory Diseases

102. Rubeola, Rubella, Mumps, and Parvovirus Infections

103. Enteroviral Infections

104. Insect- and Animal-Borne Viral Infections

Rabies

Infections Caused by Arthropod- and Rodent-Borne Viruses

Ebola and Marburg Virus Infections

105. HIV Infection and AIDS

106. Fungal Infections

107. Pneumocystis Infections

108. Protozoal Infections

Chagas Disease

Sleeping Sickness

Toxoplasmosis

109. Helminthic Infections and Ectoparasite Infestations

Helminths

Nematodes

Ectoparasites