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Spontaneous Bacterial Peritonitis

more about Spontaneous Bacterial Peritonitis


  • 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.

  • Feeling ill
  • Fever
  • Abdominal pain
  • Confusion
  • Mental changes

  • Examination:
    1. Ascites (fluid) present -- abdomen is enlarged from fluid
    2. Liver may be enlarged
    3. Abdominal tenderness (only in about 50%)
    4. Tenderness to percussion (only in about 15%)
  • Laboratory:
    1. Paracentesis is performed -- fluid is taken from abdomen and sent to the laboratory to check for cell count and culture.
    2. If the total protein in the peritoneal fluid is greater than 1gram/dL, it is unlikely that spontaneous peritonitis is the diagnosis.
    3. If the cell count is greater than 250 neutrophils/uL, then the diagnosis is most likely bacterial peritonitis.
    4. 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.

  • Occurs almost exclusively in persons with Ascites (fluid in the abdomen) due to liver disease

  • Third generation Cephalosporin antibiotic such as Cefotaxime
  • Ampicillin is added if the Enterococcus infection is suspected

  • 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%.

  • 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

  • Secondary bacterial peritonitis
  • Tuberculous peritonitis
  • Peritoneal carcinomatosis




more about Spontaneous Bacterial Peritonitis


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