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Peritonitis, Acute

Marie L. Borum, MD, EdD, MPH, MACP, FACG, AGAF and WonSeok William Choi, BA Reviewed 06/2020
 


BASICS

DESCRIPTION

  • Definition: inflammation of the peritoneum

  • Classification:

    • Aseptic: chemical irritation or systemic inflammation of peritoneum

    • Bacterial: infection of peritoneal fluid

  • Bacterial peritoni...

DIAGNOSIS

HISTORY

  • SBP: history of cirrhosis or ascites, fever, chills, mental status changes, abdominal pain (diffuse, continuous; may be subtle due to presence of ascites), nausea/vomiting, diarrhea, ...

TREATMENT

GENERAL MEASURES

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Normalization of vital signs with resolution of leukocytosis is a sign of improvement. 
  • PMN decrease >25% is expected if follow-up paracentesi...

REFERENCES

1
Dever JB, Sheikh MY. Review article: spontaneous bacterial peritonitis—bacteriology, diagnosis, treatment, risk factors and prevention. Aliment Pharmacol Ther.  2015;41(11):1116–1131.

ADDITIONAL READING

SEE ALSO

Appendicitis, Acute; Cirrhosis of the Liver; Diverticular Disease; Peptic Ulcer Disease 

CODES

ICD10

  • K65.0 Generalized (acute) peritonitis

  • K65.2 Spontaneous bacterial peritonitis

  • K65.8 Other peritonitis

  • K65.9 Peritonitis, unspecified

  • K65.1 Peritoneal abscess

ICD9

  • 567.21 Peritonitis (acute) gener...

CLINICAL PEARLS

  • Maintain a high index of suspicion for SBP in cirrhotic patients with ascites (up to 30% of cases may be asymptomatic). Start empiric therapy early.

  • SBP is usually monomicrobial. Parace...

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