Changes

===Medical===

===Medical===

====Fluid therapy====

====Fluid therapy====

*Aggressive fluid therapy with crystalloid and colloid should be given on initial presentation to improve haemodynamic parameters.

*Aggressive fluid therapy with [[Crystalloids|crystalloid]] and [[Colloids|colloid]] should be given on initial presentation to improve haemodynamic parameters.

*Fluid therapy is also very important in the postoperative period.  Both crystalloid and colloid should be continued until the patient is normotensive.  However, if hypotension continues, a vasopressor such as vasopressin should be considered.

*Fluid therapy is also very important in the postoperative period.  Both crystalloid and colloid should be continued until the patient is normotensive.  However, if hypotension continues, a vasopressor such as [[Vasopressin|vasopressin]] should be considered.

*Supplementaion of glucose and potassium may be needed.

*Supplementaion of glucose and potassium may be needed.

*If severe metabolic acidosis is present, bicarbonate may be given.

*If severe metabolic acidosis is present, bicarbonate may be given.

*Septic peritonitis can cause disseminated intravascular coagulation (DIC) and therefore plasma can be given to replace clotting factors.

*Septic peritonitis can cause [[Disseminated Intravascular Coagulation - Pathology|disseminated intravascular coagulation (DIC)]] and therefore plasma can be given to replace clotting factors.

====Antimicrobial====

====Antimicrobial====

*Broad spectrum antibiotics should be given, preferably following culture and sensitivity test.  Escherichia coli, Clostridium spp. and Enterococcus spp. are most commonly isolated.   

*Broad spectrum antibiotics should be given, preferably following culture and sensitivity test.  [[Escherichia coli|Escherichia coli]], [[Clostridium species|Clostridium spp.]] and Enterococcus spp. are most commonly isolated.   

===Surgery===

===Surgery===

This may be indicated if the cause of peritonitis is undetermined or intestinal rupture or intestinal obstruction or mesenteric avulsion is suspected.  Abdominal lavage is controversial due to the possibility of dissemination of infection.  It is indicated in cases of generalised peritonitis but care has to be taken in cases of localised peritonitis.  As much of the fluid used for lavage has to be drained as it will hinder the body’s immune system otherwise.

This may be indicated if the cause of peritonitis is undetermined or intestinal rupture or intestinal obstruction or mesenteric avulsion is suspected.  Abdominal lavage is controversial due to the possibility of dissemination of infection.  It is indicated in cases of generalised peritonitis but care has to be taken in cases of localised peritonitis.  As much of the fluid used for lavage has to be drained as it will hinder the body’s immune system otherwise.

==Prognosis==

==Prognosis==