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Spontaneous Bacterial Peritonitis
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- The peritoneum is the name given for the inside of the abdomen where the stomach, intestines and colon reside. Peritonitis is a disease state in which the peritoneum becomes infected. "Spontaneous" means that the infection occurred without a specific cause. Secondary Bacterial Peritonitis is an infection that occurs due to specific causes, such as when the bowel is perforated and feces gets into the peritoneum.
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- Feeling ill
- Fever
- Abdominal pain
- Confusion
- Mental changes
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- Ascites (fluid)
present -- abdomen is enlarged from fluid
- Liver may be enlarged
- Abdominal tenderness (only in about 50%)
- Tenderness to percussion (only in about 15%)
- Paracentesis is performed -- fluid is taken from abdomen and sent to the laboratory to check for cell count and culture.
- If the total protein in the peritoneal fluid is greater than 1gram/dL, it is unlikely that spontaneous peritonitis is the diagnosis.
- If the cell count is greater than 250 neutrophils/uL, then the diagnosis is most likely bacterial peritonitis.
- If cell count is greater than 10,000 neutrophils/uL, glucose level is low(<50mg/dL), LDH is greater than serum LDH, or total protein is above 1 gram, all suggest secondary bacterial peritonitis.
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- Occurs almost exclusively in persons with Ascites (fluid in the abdomen) due to liver disease
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- Third generation Cephalosporin antibiotic such as Cefotaxime
- Ampicillin is added if the Enterococcus infection is suspected
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- You need immediate emergency medical treatment. If treated early, there is an over 90% cure rate, but if it is not caught early, there is risk of death of approximately 50%.
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- In those persons who have had repeat episodes of Spontaneous Bacterial Peritonitis, prophylaxis (continued treatment)
with daily antibiotics such as Trimethoprim-sulfamethoxazole
or Norfloxacin.
- If persons who have not had Spontaneous Bacterial Peritonitis, but are at high risk (low-protein <1gram/dL in peritoneal fluid), are usually treated with prophylactic Trimethoprim-Sulfamethoxazole (5 days per week) or ciprofloxacin once a week
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- Secondary bacterial peritonitis
- Tuberculous peritonitis
- Peritoneal carcinomatosis
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