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Inflammation of the peritoneal lining of the abdominal cavity
Primary: without an intra-abdominal source
Secondary: caused by viscus rupture/perforation, bowel necrosis, or extension of an intraperitoneal organ infection or abscess
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Most commonly associated with nephrotic syndrome, liver failure, acute abdominal infections (i.e., appendicitis)
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CAUSES OF SECONDARY PERITONITIS
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Ruptured appendicitis
Incarcerated hernia
Midgut volvulus
Meckel's diverticulum
Intussusception
Necrotizing enterocolitis (NEC)
Hemolytic uremic syndrome (HUS)
Ruptured peptic ulcer
Trauma
Genital tract infections and pelvic inflammatory disease (PID): mixed flora, Neisseria, Chlamydia, anaerobes
Foreign bodies: ventriculoperitoneal (VP) shunts, peritoneal dialysis (PD) catheters
Autoimmune disorders: systemic lupus erythematosus (SLE)
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CLINICAL MANIFESTATIONS
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Fever, abdominal pain, anorexia, vomiting, diarrhea, acute abdomen, mental status changes, toxic appearance, shock.
Clinical signs may be unreliable; therefore, have a low threshold for diagnostic paracentesis.
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LABORATORY EVALUATION
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Complete blood count (CBC): increased white blood cells (WBCs) with neutrophil predominance
Urinalysis (UA): proteinuria
Ascitic fluid: >250 polys/mm2, increased lactate, decreased pH (<7.35), Gram stain with organisms
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See Surviving Sepsis Guidelines to reverse shock.
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ANTIMICROBIAL THERAPY
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SURGICAL INTERVENTION
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SUGGESTED READINGS
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Rangel SJ, Moss RL. Chapter 69: Peritonitis. In: Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Churchill Livingstone–An Imprint of Elsevier Science; 2009:420.
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Solomkin JS, Mazuski JE, Bradley JS,
et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America.
Clin Infect Dis. 2010;50:133–164.
[PubMed: 20034345]