**Core Concept**
Primary peritonitis is a form of peritonitis that arises from bacterial translocation into the peritoneal cavity without an overt abdominal surgical or traumatic source. It is most commonly associated with underlying systemic conditions that impair host defense, especially liver disease.

**Why the Correct Answer is Right**
Primary peritonitis occurs when bacteria from the gut translocate into the peritoneal cavity due to impaired intestinal barrier function. In cirrhosis, portal hypertension and reduced immune function lead to increased bacterial translocation. This predisposes patients to primary peritonitis, which is the most common type of peritonitis in patients with advanced liver disease. It is typically caused by gram-negative bacteria, not monobacterial, and does not require peritoneal lavage as a standard treatment.

**Why Each Wrong Option is Incorrect**
Option A: Primary peritonitis is usually **polybacterial**, not monobacterial, with common pathogens like *Escherichia coli* and *Klebsiella*.
Option B: Chemical peritonitis is a term used for inflammation due to toxins, not a stage of peritonitis. It does not proceed secondary peritonitis; secondary peritonitis follows abdominal wall or organ perforation.
Option C: Peritoneal lavage is not required for diagnosis or treatment of primary peritonitis; it is used in cases of severe secondary peritonitis or infected peritonitis.

**Clinical Pearl / High-Yield Fact**
In cirrhosis, primary peritonitis is a **classic complication** and a **key indicator of decompensated liver disease**. Early detection and treatment with antibiotics (e.g., ceftriaxone) are essential to prevent progression to sepsis.

✓ Correct Answer: D. Occurs with Cirrhosis of liver