CLINICAL PRESENTATION OF PRIMARY PERITONITIS
Primary peritonitis in children may mimic acute appendicitis, with fever, abdominal pain, nausea, vomiting, diarrhea, diffuse abdominal tenderness, rebound tenderness, and hypoactive or absent bowel sounds. In cirrhotic patients, the presentation is often atypical and may present insidiously with no signs of peritoneal irritation. The most frequent symptoms are fever (69%) and abdominal pain (59%). Other signs and symptoms include hepatic encephalopathy (54%), abdominal tenderness (49%), diarrhea (32%), ileus (30%), shock (21%), and hypothermia (17%). Approximately 10% of patients with SBP have no signs or symptoms. Because of the variable clinical picture, patients with cirrhosis who have unexplained deterioration, especially hepatic encephalopathy, should undergo a diagnostic paracentesis.Tuberculous peritonitis usually appears gradually, with fever, malaise, weight loss, night sweats, and abdominal distension. The abdomen is often described as being “doughy” on palpation. Surgery or laparoscopy typically reveals multiple nodules over the peritoneal and omental surfaces with adhesions. C. immitis causes a granulomatous peritonitis and manifests variably.*88/348/5*
