Spontaneous Bacterial Peritonitis Differential Diagnoses

  • Author: Thomas E Green, DO, MPH, FACOEP, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Dec 7, 2011
 
 

Diagnostic Considerations

  • Secondary bacterial peritonitis
  • Perforated viscus
  • Pyelonephritis

Clinical features do not distinguish secondary bacterial peritonitis from spontaneous bacterial peritonitis. However, patients with secondary bacterial peritonitis have a surgically treatable source of infection (eg, perforated duodenal ulcer, perinephric abscess).

In secondary bacterial peritonitis from free perforation of a viscus, the peritoneal fluid analysis characteristically shows an extremely elevated polymorphonuclear neutrophil count, multiple organisms (often including fungi and Enterococcus) on Gram stain and culture, and at least two of the following criteria[4] :

  • Total protein greater than 1 g/dL
  • Lactate dehydrogenase above the upper limit of normal for serum
  • Glucose less than 50 mg/dL

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Thomas E Green, DO, MPH, FACOEP, FACEP  Attending Physician, Emergency Department, Franciscan Saint James Hospital; Assistant Professor and Core Faculty, Emergency Medicine Residency, Chicago College of Osteopathic Medicine at Midwestern University

Thomas E Green, DO, MPH, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Coauthor(s)

Steven M Bandy, MD, FACEP  Adjunct Clinical Professor of Emergency Medicine, Virginia College of Osteopathic Medicine; Staff Physician, Department of Emergency Medicine, Johnston Memorial Hospital; Medical Director, Rejuvenage Medspa; Operational Medical Director, Virginia Operations, Wings Air Rescue Ambulance Service

Steven M Bandy, MD, FACEP is a member of the following medical societies: American Academy of Cosmetic Surgery, American College of Emergency Physicians, and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References
  1. Lata J, Stiburek O, Kopacova M. Spontaneous bacterial peritonitis: a severe complication of liver cirrhosis. World J Gastroenterol. Nov 28 2009;15(44):5505-10. [Medline]. [Full Text].

  2. Bert F, Noussair L, Lambert-Zechovsky N, Valla D. Viridans group streptococci: an underestimated cause of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Eur J Gastroenterol Hepatol. Sep 2005;17(9):929-33. [Medline].

  3. Cholongitas E, Papatheodoridis GV, Lahanas A, Xanthaki A, Kontou-Kastellanou C, Archimandritis AJ. Increasing frequency of Gram-positive bacteria in spontaneous bacterial peritonitis. Liver Int. Feb 2005;25(1):57-61. [Medline].

  4. [Guideline] Runyon BA. Management of adult patients with ascites due to cirrhosis: an update. Hepatology. Jun 2009;49(6):2087-107. [Medline].

  5. Riggio O, Angeloni S. Ascitic fluid analysis for diagnosis and monitoring of spontaneous bacterial peritonitis. World J Gastroenterol. Aug 21 2009;15(31):3845-50. [Medline]. [Full Text].

  6. Chinnock B, Gomez R, Hendey GW. Peritoneal fluid cultures rarely alter management in patients with ascites. J Emerg Med. Jan 2011;40(1):21-4. [Medline].

  7. Gaya DR, David B Lyon T, Clarke J, Jamdar S, Inverarity D, Forrest EH, et al. Bedside leucocyte esterase reagent strips with spectrophotometric analysis to rapidly exclude spontaneous bacterial peritonitis: a pilot study. Eur J Gastroenterol Hepatol. Apr 2007;19(4):289-95. [Medline].

  8. Runyon BA. Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. Hepatology. Oct 1990;12(4 Pt 1):710-5. [Medline].

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