Template:Spontaneous versus secondary bacterial peritonitis

Spontaneous versus secondary bacterial peritonitis

• Importance of distinction
  • Mortality of secondary bacterial peritonitis (eg. perforated appendicitis, cholecystitis) ~100% if treatment is only antibiotics without surgery
  • Mortality of unnecessary surgery in patients with SBP ~80%
• Laboratory findings
  • Secondary bacterial peritonitis strongly suggested by:
    • Neutrocytic fluid (PMN ≥250) w/ two or more of the following:
      • Total protein concentration >1 g/dL (10 g/L)
      • Glucose concentration <50 mg/dL (2.8 mmol/L)
      • LDH greater than upper limit of normal for serum
    • Ascitic alk phos >240
    • Gram stain
      • Large numbers of different bacterial forms
• Imaging
  • If evidence of secondary bacterial peritonitis obtain abdominal imaging
    • If no evidence of free air or contrast extravasation then surgery is not indicated