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Peritonitis, Acute

Nadeem Tabbara, MD and Marie L. Borum, MD, EdD, MPH, MACP, FACG, AGAF Reviewed 06/2019
 


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, mental status changes, abdominal pain, chills, nausea/vomiting, GI bleed

  • Secondary bacterial peritonitis: may be clinically indistinguishab...

TREATMENT

GENERAL MEASURES

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

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

REFERENCES

1
Alaniz C, Regal RE. Spontaneous bacterial peritonitis: a review of treatment options. P T.  2009;34(4):204–210. [View Abstract on OvidMedline]
2
Panhofer P, Izay B, Riedl M, et al. Age,...

ADDITIONAL READING

  • Bajaj JS, O’Leary JG, Wong F, et al. Bacterial infections in end-stage liver disease: current challenges and future directions. Gut.  2012;61(8):1219–1225. [View Abstract on Ov...

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 to improve outcomes.

  • Paracentesis is ...

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