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Peritonitis, Acute

Marie L Borum, MD, EdD, MPH and Junseo Bernard Lee, MD Reviewed 04/2024
 


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 and/or ascites, fever, chills, mental status changes, abdominal pain (diffuse, continuous; may be subtle due to presence of ascites), nausea/vomiting, diarrh...

TREATMENT

GENERAL MEASURES

  • Control ascites with salt restriction, spironolactone ±, furosemide, albumin infusion after large-volume paracentesis, and/or lactulose for encephalopathy.

  • Discontinue β-block...

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 repeat paracentesis i...

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.
2
Li PK...

ADDITIONAL READING

  • Aithal GP, Palaniyappan N, China L, et al. Guidelines on the management of ascites in cirrhosis. Gut. 2021;70(1):9–29.

  • Mattos AA...

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

SNOMED

  • 67602004 Acute peritonitis

  • 1183...

CLINICAL PEARLS

  • Maintain a high index of suspicion for SBP in cirrhotic patients with ascites (up to one-third of cases may be asymptomatic) and start empiric antibiotic therapy early.

  • SBP is usually m...

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