Materiały źródłowe

• #1 Peritonitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peritonitis/symptoms-causes/syc-20376247

  Peritonitis can be life-threatening if you don’t get treatment quickly. […] It’s important to get treatment fast for peritonitis. Health care providers have ways to clear out the infection. […] Peritonitis that happens without a hole or tear is called spontaneous bacterial peritonitis. […] Your health care provider may prescribe antibiotics to prevent peritonitis, especially if you’ve had peritonitis before. […] Peritonitis can happen in people who get this treatment. […] Peritonitis may cause a whole-body infection called sepsis.

• #2 Peritonitis | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/peritonitis

  Peritonitis is life threatening if not treated promptly. […] Diagnosis of peritonitis involves a number of tests, including: […] Physical examination the abdomen is hard and painful. There are no bowel movements or sounds. […] Blood tests to check for which bacteria are responsible. […] X-rays of the abdomen. […] Laparoscopy a slender tube is inserted through an abdominal incision and the insides examined. […] Peritoneal fluid culture a sample of fluid is taken and examined for signs of infection.

• #3 Peritonitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peritonitis/diagnosis-treatment/drc-20376250

  To diagnose peritonitis, your health care provider talks with you about your medical history and gives you a physical exam. Your symptoms alone may be enough for your provider to diagnose the condition if your peritonitis is linked to peritoneal dialysis. […] If more tests are needed to confirm a diagnosis, your health care provider may suggest: […] Blood tests. A sample of your blood may be taken to see if you have an increase in disease-fighting white blood cells. This is usually a sign of an infection or inflammation. You also might have a blood culture test to find out if bacteria are in your blood. […] Imaging tests. You may have an X-ray exam to check for holes or other tears in your digestive tract. You also may have a test that uses sound waves to make images inside your body, called ultrasound. In some cases, you may have a CT scan.

• #4 Peritonitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/17831-peritonitis

  Your healthcare provider will begin by asking about your medical history and current conditions. […] They will physically examine your abdomen and check to see if it is swollen, sensitive to the touch or rigid. If it is, they will follow up with a blood test to check for evidence of inflammation or infection (high white blood cell count). […] One way to confirm and identify the specific infection in your peritoneum is to draw out some of the fluid with a needle (paracentesis) and test it in a lab (peritoneal fluid culture). […] In cases of ascites, this can also help relieve pressure in your abdomen. […] In more difficult cases, when your healthcare provider cant find the cause of your peritonitis, they may need to explore your abdominal cavity in surgery to find and fix the problem.

• #5 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Peritonitis-Diagnosis.aspx

  Peritonitis is an inflammation of the serous membranes of the peritoneal cavity. Clinical history and attentive physical examination are key factors in making a timely diagnosis of this condition. Signs and symptoms of peritonitis depend on the severity and extent of the infection, as well as the age and general health of the patient. With these factors in mind, different diagnostic tests are pursued in order to establish a correct diagnosis. […] Abdominal pain represents the hallmark symptom of peritonitis. It can be continuous and different from tense ascites, and is often accompanied by tenderness as a common feature. The pains location, character, area of radiation, change over time, and provocative factors are key pieces of information in assisting with the diagnosis. […] Laboratory studies are commonly performed, but are often non-specific in establishing the diagnosis of peritonitis. Blood samples can reveal leukocytosis with left shift and acidosis, although these measurements can be deceitful in the elderly and frequently not impressive in patients who had a recent onset of a perforated appendix.

• #6 Generalized peritonitis lead to shock: Diagnosis and management

  https://jjgastro.com/articles/JJGR-v1-1004.html

  Aim of this article is to review diagnosis and management of generalized peritonitis. […] Symptoms and signs usually relate to the spreading process within the abdominal cavity. […] The clinical manifestations can be divided into (1) abdominal signs originating from the onset of inflammation and (2) manifestations of systemic infection. Local findings include abdominal pain, tenderness, stiffness of the abdominal wall, distension, free air in the peritoneal cavity and decreased bowel sounds which are signs of irritation of the parietal peritoneum and causing ileus. Systemic findings include fever, chills, tachycardia, sweating, tachypnea, restlessness, dehydration, oliguria, disorientation and ultimately a shock. […] The most common symptom of peritonitis is abdominal pain. Pain usually comes with a sudden onset, is severe and in patients with perforation the pain is found in all parts of the abdomen.

• #7 Peritonitis – Wikipedia

  https://en.wikipedia.org/wiki/Peritonitis

  Peritonitis is inflammation of the localized or generalized peritoneum, the lining of the inner wall of the abdomen and covering of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. […] Diagnosis is generally based on examination, blood tests, and medical imaging. […] A diagnosis of peritonitis is based primarily on the clinical manifestations described above. Rigidity (involuntary contraction of the abdominal muscles) is the most specific exam finding for diagnosing peritonitis. […] In people with ascites, a diagnosis of peritonitis is made via paracentesis (abdominal tap): More than 250 polymorphonuclear cells per L is considered diagnostic.

• #8 Peritonitis Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/condition/peritonitis

  Peritonitis is an emergency and can be life threatening. Your doctor will do a physical examination to see whether you need surgery to fix the underlying problem. The doctor will feel and press your abdomen to find any swelling and tenderness, and look for signs that fluid has collected in the area. The doctor may listen to bowel sounds and check for: […] The following procedures also may be performed: […] Blood tests, to see if there is bacteria in your blood […] Test samples of fluid from the abdomen, to identify the bacteria causing the infection […] CT scan, to identify fluid in the abdomen, or an infected organ […] X-rays, to spot air in the abdomen, which means that an organ may be torn or perforated.

• #9 Pulsenotes | Peritonitis

  https://app.pulsenotes.com/surgery/general-surgery/notes/peritonitis

  Peritonitis is usually a clinical diagnosis that is confirmed with imaging in modern healthcare. […] Peritonitis is classically a clinical diagnosis based on a typical history of acute, severe abdominal pain with peritonism on examination (i.e. guarding, rigidity, rebound tenderness). […] Nonetheless, the role of imaging (particularly CT) has been increasing in patients presenting with an acute abdomen due to the ease of access to CT within the UK. Consequently, many patients will undergo a CT to evaluate the cause of acute abdominal pain, including suspected peritonitis, before considering surgical intervention. […] Patients presenting with suspected peritonitis need urgent blood tests. These help towards the suspected diagnosis (e.g. raised inflammatory markers), determine the extent of organ dysfunction/hypoperfusion (e.g. lactate), and ensure it is safe to proceed to an operation if necessary.

• #10 Peritonitis | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/peritonitis

  Peritonitis is life threatening if not treated promptly. […] Diagnosis of peritonitis involves a number of tests, including: […] Physical examination the abdomen is hard and painful. There are no bowel movements or sounds. […] Blood tests to check for which bacteria are responsible. […] X-rays of the abdomen. […] Laparoscopy a slender tube is inserted through an abdominal incision and the insides examined. […] Peritoneal fluid culture a sample of fluid is taken and examined for signs of infection.

• #11 Acute Bacterial Peritonitis in Adults

  https://www.uspharmacist.com/article/acute-bacterial-peritonitis-in-adults

  As drug experts, pharmacists are looked upon to provide appropriate guidance for the treatment of acute bacterial peritonitis in the hospital setting. Appropriate identification and treatment of acute bacterial peritonitis are keys to better outcomes. […] Classification of peritonitis is useful in clinical practice as it can help facilitate appropriate diagnosis and treatment. […] The nonspecific clinical presentation of primary peritonitis varies drastically from the conspicuous presentation of secondary peritonitis. […] In contrast, patients with secondary peritonitis often present with a boardlike abdomen, abdominal distention, faint bowel sounds that diminish over time, and excruciating abdominal pain that leads to involuntary guarding, with minute movements such as breathing or rocking of the bed causing severe pain.

• #12 Generalized peritonitis lead to shock: Diagnosis and management

  https://jjgastro.com/articles/JJGR-v1-1004.html

  Aim of this article is to review diagnosis and management of generalized peritonitis. […] Symptoms and signs usually relate to the spreading process within the abdominal cavity. […] The clinical manifestations can be divided into (1) abdominal signs originating from the onset of inflammation and (2) manifestations of systemic infection. Local findings include abdominal pain, tenderness, stiffness of the abdominal wall, distension, free air in the peritoneal cavity and decreased bowel sounds which are signs of irritation of the parietal peritoneum and causing ileus. Systemic findings include fever, chills, tachycardia, sweating, tachypnea, restlessness, dehydration, oliguria, disorientation and ultimately a shock. […] The most common symptom of peritonitis is abdominal pain. Pain usually comes with a sudden onset, is severe and in patients with perforation the pain is found in all parts of the abdomen.

• #13 Peritonitis: Symptoms, Causes, Treatments, and More

  https://www.healthline.com/health/peritonitis

  Peritonitis is a serious condition that requires immediate medical attention. The infection can spread and become life threatening if it isnt treated promptly. […] The first step in treating peritonitis is determining its underlying cause. […] If you have symptoms of peritonitis, seek medical attention right away. Delaying your treatment could put your life at risk. […] Several other tests can help a doctor diagnose peritonitis: A blood test, called a complete blood count (CBC), can measure your white blood cell (WBC) and red blood cell (RBC) count. A high WBC count usually signals inflammation or infection. A low RBC count may indicate intra-abdominal bleeding. A blood culture can help to identify the bacteria causing the infection or inflammation. […] Imaging tests, such as CT scans and X-rays, can show any perforations or holes in your peritoneum.

• #14 Peritonitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peritonitis/diagnosis-treatment/drc-20376250

  To diagnose peritonitis, your health care provider talks with you about your medical history and gives you a physical exam. Your symptoms alone may be enough for your provider to diagnose the condition if your peritonitis is linked to peritoneal dialysis. […] If more tests are needed to confirm a diagnosis, your health care provider may suggest: […] Blood tests. A sample of your blood may be taken to see if you have an increase in disease-fighting white blood cells. This is usually a sign of an infection or inflammation. You also might have a blood culture test to find out if bacteria are in your blood. […] Imaging tests. You may have an X-ray exam to check for holes or other tears in your digestive tract. You also may have a test that uses sound waves to make images inside your body, called ultrasound. In some cases, you may have a CT scan.

• #15 Generalized peritonitis lead to shock: Diagnosis and management

  https://jjgastro.com/articles/JJGR-v1-1004.html

  In some severe cases, shock can occur due to two factors. First due to the movement of intravascular fluid into the peritoneal cavity or to the lumen from the intestines. The second is due to generalized sepsis. […] Vital signs are very useful in assessing the degree of severity or complications that arise in peritonitis. […] The simplest tests to do include a blood cell count and urinalysis. In cases of peritonitis the white blood cell count is usually more than 20,000 / mm3, except in very old patients or someone who has previously had an infection and the body cannot exert its defense mechanisms. […] The main management of peritonitis includes administration of fluids and electrolytes, operative control of sepsis and administration of systemic antibiotics. […] The primary therapy for peritonitis is surgery. Surgery is usually performed to control the source of peritoneal contamination.

• #16 Peritonitis: Causes, Symptoms and Treatments.

  https://www.webmd.com/digestive-disorders/peritonitis-symptoms-causes-treatments

  If you have any symptoms of peritonitis, call your doctor right away. The doctor will ask about your symptoms and medical history, and do a thorough physical examination. They’ll check for tension and tenderness in your belly. […] You may get some tests, including: Blood tests to look for infection and inflammation, Imaging tests, such as X-rays and CT scans, to look for holes and tears in your digestive tract, Exploratory surgery to find out what’s causing your problems. […] Your doctor also may perform a paracentesis, a procedure to take fluid from the abdominal cavity with a thin needle. The test can check for infection and may relieve some pressure if you have fluid buildup in your belly.

• #17 Procalcitonin and C-reactive protein in the diagnosis of spontaneous bacterial peritonitis – Verma – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/6371/html

  Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhosis and is associated with high morbidity and mortality. […] Procalcitonin and C-reactive protein (CRP) are non-invasive markers of infection. We conducted a study to illustrate the role of these markers in making the diagnosis of SBP in patients with cirrhosis. […] Serum procalcitonin could be used as an adjunctive non-invasive biomarker in diagnosing SBP with a high degree of accuracy in cirrhotic patients. Addition of CRP does not seem to significantly increase the diagnostic accuracy of procalcitonin. […] Procalcitonin has been studied in the setting of SBP and serum procalcitonin values have almost invariably been found to be significantly higher in patients with SBP than those without it. […] In conclusion, while ascitic fluid neutrophil count still remains the gold standard, results of our study suggest that procalcitonin may be a helpful adjunct in making the diagnosis of SBP in patients with decompensated cirrhosis. In our study, we did not find any significant increase in diagnostic accuracy for SBP when CRP is added to procalcitonin.

• #18 Spontaneous Bacterial Peritonitis (SBP) – EMCrit Project

  https://emcrit.org/ibcc/sbp/

  SBP is often subtle (for example, 13% of patients are asymptomatic).(19266595) […] SBP usually occurs in the context of large-volume ascites which should be easily accessible via paracentesis. If the patient has a small volume of ascites which isn’t easily sampled, then high-risk paracentesis is not beneficial. Serial ultrasonography may be performed to determine if the ascites expands over time, at which point paracentesis may be reconsidered. […] SBP has the capacity to cause organ failures, with many parallels to septic shock. […] Diagnostic paracentesis should be performed promptly (e.g., 12 hours after admission to the hospital, for patients with cirrhosis and ascites).(34182617) […] Three criteria are required: (1) Chronic underlying cirrhosis. (2) Ascites neutrophil count 250/mm3. (3) Exclusion of secondary bacterial peritonitis (discussed in the section above).

• #19 Peritonitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peritonitis/diagnosis-treatment/drc-20376250

  Peritoneal fluid analysis. In this test, a thin needle is used to take a sample of the fluid in your peritoneum. You’re more likely to have this test if you get peritoneal dialysis or if you have fluid in your abdomen from liver disease. An increased white blood cell count in this fluid usually points to an infection or inflammation. A culture of the fluid may be used to spot bacteria.

• #20 Peritonitis and Abdominal Sepsis Workup: Approach Considerations, Laboratory Studies, Peritoneal Fluid Analysis

  https://emedicine.medscape.com/article/180234-workup

  Perform a diagnostic paracentesis in all patients with new-onset ascites that can be sampled. Initial laboratory studies of ascitic fluid should include ascitic fluid neutrophil count, total protein, and albumin, as well as serum albumin. […] Diagnostic paracentesis should be performed in all patients who do not have an indwelling peritoneal catheter and are suspected of having spontaneous bacterial peritonitis (SBP). […] The results of aerobic and anaerobic bacterial cultures, used in conjunction with the cell count, prove the most useful in guiding therapy for those with SBP. […] The single best predictor of spontaneous bacterial peritonitis (SBP) is an ascitic fluid neutrophil count of greater than 500 cells/L, which carries a sensitivity of 86% and a specificity of 98%. […] The diagnosis of SBP is established when the polymorphonuclear neutrophil (PMN) count is 250 cells/L or greater in conjunction with a positive bacterial culture result.

• #21 Peritonitis laboratory findings – wikidoc

  https://www.wikidoc.org/index.php/Peritonitis_laboratory_findings

  Diagnosis requires paracentesis (needle drainage of the ascitic fluid). Ascites culture is negative in up to 60% of patients with clinical manifestations of spontaneous bacterial peritonitis (SBP), therefore, the diagnosis is based on the neutrophil count, which reaches its highest sensitivity with a cutoff neutrophil count of 250/mm3. […] A diagnosis of peritonitis is based primarily on clinical grounds, that is on the clinical manifestations described above; if they support a strong suspicion of peritonitis, no further investigation should delay surgery. […] Laboratory tests, most importantly ascitic fluid analysis is required for confirmation of diagnosis of spontaneous bacterial peritonitis. […] Early Diagnostic paracentesis (72hrs) is recommended to perform in all cirrhotic patients with ascites at the time of admission and/or in case of gastrointestinal (GI) bleeding, shock, signs of inflammation, hepatic encephalopathy, worsening of liver or renal function.

• #22 Spontaneous bacterial peritonitis – Wikipedia

  https://en.wikipedia.org/wiki/Spontaneous_bacterial_peritonitis

  Spontaneous bacterial peritonitis (SBP) is the development of a bacterial infection in the peritoneum, despite the absence of an obvious source for the infection. The diagnosis of SBP requires paracentesis, a sampling of the peritoneal fluid taken from the peritoneal cavity. If the fluid contains large numbers of white blood cells known as neutrophils (250 cells/L), infection is confirmed and antibiotics will be given, without waiting for culture results. […] Diagnosis is made by paracentesis (needle aspiration of the ascitic fluid); SBP is diagnosed if the fluid contains neutrophils at greater than 250 cells per mm3 (equals a cell count of 250 x106/L) fluid in the absence of another reason for this (such as inflammation of one of the internal organs or a perforation). The fluid is also cultured to identify bacteria. If the sample is sent in a plain sterile container, 40% of samples will identify an organism, while if the sample is sent in a bottle with culture medium, the sensitivity increases to 7290%.

• #23 Peritonitis laboratory findings – wikidoc

  https://www.wikidoc.org/index.php/Peritonitis_laboratory_findings

  Absolute neutrophil count – a total count of 250 cells/mm3 confirm the diagnosis of spontaneous bacterial peritonitis. […] When culture is positive, the most common organisms are Gram-negative bacteria (mainly Escherichia coli) and Gram-positive cocci (usually Streptococcus spp. and enterococci). […] If the diagnosis is doubtful, the serum procalcitonin level has a 95% sensitivity, and 98% specificity with a 0.75 ng/mL cutoff. […] Some patients may have an ascitic neutrophil count 250 cells/mm3 with positive cultures. This is known as „bacterascites”. […] Recently leukocyte esterase calibrated reagent strips (LERS) to assess the PMN cell count (cut-off of 250 PMN/mcL) are promised to provide good screening results when the strip turns any hue of tan/brown at 3 min. […] Secondary bacterial peritonitis should be suspected if the ascites PMN count is 250 cells/mm3 and two of the following three ascitic fluid values are met: (1) glucose !50 mg/dl (2) total protein 11 g/dl and (3) lactate dehydrogenase greater than the upper limit of normal for serum.

• #24 Spontaneous Bacterial Peritonitis (SBP) – EMCrit Project

  https://emcrit.org/ibcc/sbp/

  Ascitic fluid cultures are often negative, so SBP may be diagnosed without microbiological proof of infection. […] This is defined as an ascitic fluid culture positive for a single organism, yet the neutrophil count is 250/mm3. […] Guidelines recommend that patients should not receive antibiotics, since most cases are either due to contamination or may self-resolve over time. Repeat paracentesis should be performed to investigate for progression to SBP.(33942342) […] If the neutrophil count doesn’t decrease by at least 25%, this carries a substantial likelihood of treatment failure.(29653741) […] Re-consider the possibility of secondary bacterial peritonitis (and consider a CT scan of the abdomen/pelvis).(33942342)

• #25 Secondary Bacterial Peritonitis

  https://emcrit.org/pulmcrit/secondary-bacterial-peritonitis/

  The crux of this algorithm is Runyons Criteria for secondary bacterial peritonitis, which requires two of these three features: total protein 1 g/dL, glucose 50 mg/dL (2.8 mM), and lactate dehydrodgenase above the upper limit of normal for serum. […] This study suggests that the Runyon criteria are insufficiently sensitive. […] Although secondary bacterial peritonitis only constitutes ~5% of cirrhotic patients with ascites, this diagnosis has major implications for management. […] Septations should not be seen in sterile ascitic fluid from cirrhosis. The presence of septations suggests infection, either primary or secondary bacterial peritonitis. […] When concerned regarding the possibility of secondary bacterial peritonitis, there should be a low threshold to obtain a CT scan.

• #26 Spontaneous Bacterial Peritonitis (SBP) – EMCrit Project

  https://emcrit.org/ibcc/sbp/

  SBP is often subtle (for example, 13% of patients are asymptomatic).(19266595) […] SBP usually occurs in the context of large-volume ascites which should be easily accessible via paracentesis. If the patient has a small volume of ascites which isn’t easily sampled, then high-risk paracentesis is not beneficial. Serial ultrasonography may be performed to determine if the ascites expands over time, at which point paracentesis may be reconsidered. […] SBP has the capacity to cause organ failures, with many parallels to septic shock. […] Diagnostic paracentesis should be performed promptly (e.g., 12 hours after admission to the hospital, for patients with cirrhosis and ascites).(34182617) […] Three criteria are required: (1) Chronic underlying cirrhosis. (2) Ascites neutrophil count 250/mm3. (3) Exclusion of secondary bacterial peritonitis (discussed in the section above).

• #27 Core Concepts – Recognition and Management of Spontaneous Bacterial Peritonitis – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/spontaneous-bacterial-peritonitis-recognition-management/core-concept/all

  Among persons with ascites who have been followed for a year, spontaneous bacterial peritonitis (SBP) develops in approximately 10 to 30% and has an estimated in-hospital mortality rate of 20%. […] In a person with ascites, the presence of new-onset fever (temperature greater than 37.8C or 100F), abdominal pain, hepatic encephalopathy, metabolic acidosis, renal failure, hypotension, diarrhea, paralytic ileus, hypothermia, leukocytosis, or other signs or symptoms of infection should prompt a diagnostic paracentesis for ascitic fluid analysis and culture. […] Spontaneous bacterial peritonitis refers to infection of the ascitic fluid, as evidenced by an ascitic fluid absolute polymorphonuclear leukocyte (PMN) count of at least 250 cells/mm3 (0.25 109/L), with or without a positive ascitic fluid culture, in the absence of an intra-abdominal surgically treatable source of infection.

• #28 Secondary Bacterial Peritonitis

  https://emcrit.org/pulmcrit/secondary-bacterial-peritonitis/

  The crux of this algorithm is Runyons Criteria for secondary bacterial peritonitis, which requires two of these three features: total protein 1 g/dL, glucose 50 mg/dL (2.8 mM), and lactate dehydrodgenase above the upper limit of normal for serum. […] This study suggests that the Runyon criteria are insufficiently sensitive. […] Although secondary bacterial peritonitis only constitutes ~5% of cirrhotic patients with ascites, this diagnosis has major implications for management. […] Septations should not be seen in sterile ascitic fluid from cirrhosis. The presence of septations suggests infection, either primary or secondary bacterial peritonitis. […] When concerned regarding the possibility of secondary bacterial peritonitis, there should be a low threshold to obtain a CT scan.

• #29 Peritonitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peritonitis/diagnosis-treatment/drc-20376250

  To diagnose peritonitis, your health care provider talks with you about your medical history and gives you a physical exam. Your symptoms alone may be enough for your provider to diagnose the condition if your peritonitis is linked to peritoneal dialysis. […] If more tests are needed to confirm a diagnosis, your health care provider may suggest: […] Blood tests. A sample of your blood may be taken to see if you have an increase in disease-fighting white blood cells. This is usually a sign of an infection or inflammation. You also might have a blood culture test to find out if bacteria are in your blood. […] Imaging tests. You may have an X-ray exam to check for holes or other tears in your digestive tract. You also may have a test that uses sound waves to make images inside your body, called ultrasound. In some cases, you may have a CT scan.

• #30 Peritonitis Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/condition/peritonitis

  Peritonitis is an emergency and can be life threatening. Your doctor will do a physical examination to see whether you need surgery to fix the underlying problem. The doctor will feel and press your abdomen to find any swelling and tenderness, and look for signs that fluid has collected in the area. The doctor may listen to bowel sounds and check for: […] The following procedures also may be performed: […] Blood tests, to see if there is bacteria in your blood […] Test samples of fluid from the abdomen, to identify the bacteria causing the infection […] CT scan, to identify fluid in the abdomen, or an infected organ […] X-rays, to spot air in the abdomen, which means that an organ may be torn or perforated.

• #31 Peritonitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peritonitis/diagnosis-treatment/drc-20376250

  To diagnose peritonitis, your health care provider talks with you about your medical history and gives you a physical exam. Your symptoms alone may be enough for your provider to diagnose the condition if your peritonitis is linked to peritoneal dialysis. […] If more tests are needed to confirm a diagnosis, your health care provider may suggest: […] Blood tests. A sample of your blood may be taken to see if you have an increase in disease-fighting white blood cells. This is usually a sign of an infection or inflammation. You also might have a blood culture test to find out if bacteria are in your blood. […] Imaging tests. You may have an X-ray exam to check for holes or other tears in your digestive tract. You also may have a test that uses sound waves to make images inside your body, called ultrasound. In some cases, you may have a CT scan.

• #32 Pulsenotes | Peritonitis

  https://app.pulsenotes.com/surgery/general-surgery/notes/peritonitis

  Imaging has become a mainstay investigation of the acute abdomen and suspected peritonitis. In modern healthcare, CT is often used as the first-line investigation to assess the whole of the intra-abdominal and pelvic organs. […] Patients with peritonitis often require urgent surgical exploration. […] Any patient with suspected peritonitis should be urgently referred to the appropriate surgical team for further management, which commonly involves surgical intervention. […] The management of peritonitis depends on whether it is primary or secondary, localised or generalised, and on the suspected underlying cause. In those who need urgent surgical intervention, an exploratory laparotomy is commonly performed.

• #33 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Peritonitis-Diagnosis.aspx

  Computerized tomography (CT) scans of the abdomen and pelvis, generally with both oral and intravenous contrast, is increasingly preferred as the most sensitive and specific imaging technique for acute abdominal pain. It is much more sensitive than plain films for the detection of free air. […] If spontaneous bacterial peritonitis is suspected, paracentesis should be performed, since the analysis of ascitic fluid is considered the mainstay of diagnosis. A polymorphonuclear (PMN) cell count that is greater than 250 cells per mm3 and the yield of cultures of the ascitic fluid represent the gold standard in diagnosing this condition. […] Finally, diagnostic laparoscopy is extremely accurate in making the diagnosis of surgical peritonitis while also providing a better understanding of the underlying diseases. Female patients with gynecologic diseases can especially benefit from such an approach, which may prevent unnecessary laparotomy.

• #34 Pulsenotes | Peritonitis

  https://app.pulsenotes.com/surgery/general-surgery/notes/peritonitis

  Imaging has become a mainstay investigation of the acute abdomen and suspected peritonitis. In modern healthcare, CT is often used as the first-line investigation to assess the whole of the intra-abdominal and pelvic organs. […] Patients with peritonitis often require urgent surgical exploration. […] Any patient with suspected peritonitis should be urgently referred to the appropriate surgical team for further management, which commonly involves surgical intervention. […] The management of peritonitis depends on whether it is primary or secondary, localised or generalised, and on the suspected underlying cause. In those who need urgent surgical intervention, an exploratory laparotomy is commonly performed.

• #35 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Peritonitis-Diagnosis.aspx

  Computerized tomography (CT) scans of the abdomen and pelvis, generally with both oral and intravenous contrast, is increasingly preferred as the most sensitive and specific imaging technique for acute abdominal pain. It is much more sensitive than plain films for the detection of free air. […] If spontaneous bacterial peritonitis is suspected, paracentesis should be performed, since the analysis of ascitic fluid is considered the mainstay of diagnosis. A polymorphonuclear (PMN) cell count that is greater than 250 cells per mm3 and the yield of cultures of the ascitic fluid represent the gold standard in diagnosing this condition. […] Finally, diagnostic laparoscopy is extremely accurate in making the diagnosis of surgical peritonitis while also providing a better understanding of the underlying diseases. Female patients with gynecologic diseases can especially benefit from such an approach, which may prevent unnecessary laparotomy.

• #36 Peritonitis-an Overview – Bezmialem Science

  https://bezmialemscience.org/articles/peritonitis-an-overview/doi/bas.galenos.94695

  In this issue, I will make an overview of peritonitis and its classification, which is a common issue in emergency services and causes mortality if the diagnosis is delayed. […] Peritonitis describes the inflammatory process of the peritoneum, which is usually due to infection, but peritonitis can also be a sterile process. […] Diagnosis of ascitic fluid infection is based on clinical suspicion and analysis of ascitic fluid, particularly white cell count and culture in blood culture bottles. […] The diagnosis is mostly made with imaging methods such as ultrasonography, computed tomography and MRI. Abdominal paracentesis may be helpful in undiagnosed cases. […] Today the gold standard for diagnosis is diagnostic laparoscopy. Since laparoscopy allows treatment as well as diagnosis, it should be performed on patients who cannot be diagnosed with imaging methods. […] In conclusion, it should not be forgotten that early diagnosis of peritonitis is life-saving. Diagnosis will enable us to determine which type of peritonitis it is and ultimately plan the most effective treatment method.

• #37 Peritonitis | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/peritonitis

  Peritonitis is life threatening if not treated promptly. […] Diagnosis of peritonitis involves a number of tests, including: […] Physical examination the abdomen is hard and painful. There are no bowel movements or sounds. […] Blood tests to check for which bacteria are responsible. […] X-rays of the abdomen. […] Laparoscopy a slender tube is inserted through an abdominal incision and the insides examined. […] Peritoneal fluid culture a sample of fluid is taken and examined for signs of infection.

• #38 Peritonitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/peritonitis?lang=us

  Peritonitis refers to any form inflammation of the peritoneum. […] Peritonitis can be localized or generalized, and may be infective or non-infective in etiology: […] infective peritonitis […] bacterial peritonitis […] primary: from diffuse bacterial infection of the peritoneal cavity occurring without loss of integrity of the digestive tract. […] secondary […] acute infection of the peritoneal cavity, usually resulting from perforation or anastomotic disruption of the digestive tract (e.g. fecal peritonitis) […] sometimes arise from acute abdominal inflammatory conditions, peritoneal dialysis, and systemic infections. […] non-infective peritonitis […] may result from sterile involvement of the peritoneum such as in eosinophilic peritonitis or encapsulating peritoneal sclerosis

• #39 Peritonitis differential diagnosis – wikidoc

  https://wikidoc.org/index.php/Peritonitis_differential_diagnosis

  Differentiating Secondary peritonitis from other causes of peritonitis […] Diagnosed by analysis of the ascitic fluid which reveals WBC 500/ML, and PMN 250cells/ml. […] Definitive diagnosis in 80% of cases is by culture. […] Diagnosis is suspected in any patient with a predisposing condition. […] Diagnosed best by CT scan of the abdomen. […] CT with intravenous contrast typically demonstrates the thickening of the peritoneum. Laparoscopy with tissue biopsy or CT guided tissue biopsy with immunohistochemical staining for calretinin, cytokeratin 5/6, mesothelin, and Wilms tumor 1 antigen remain the gold standard for diagnosis.

• #40 Spontaneous bacterial peritonitis in adults: Diagnosis – UpToDate

  https://www.uptodate.com/contents/spontaneous-bacterial-peritonitis-in-adults-diagnosis

  Spontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without an evident intra-abdominal surgically treatable source. The presence of SBP, which almost always occurs in patients with cirrhosis and ascites, is suspected because of suggestive signs and symptoms, such as fever, abdominal pain, or altered mental status, though some patients are asymptomatic and are detected when they undergo paracentesis after being admitted to the hospital for another reason. […] This topic will review the diagnosis of SBP, as well as distinguishing SBP from secondary bacterial peritonitis or alcoholic hepatitis with ascites. […] Spontaneous bacterial peritonitis (SBP) should be suspected in patients with cirrhosis who develop signs or symptoms such as fever, abdominal pain, altered mental status, abdominal tenderness, or hypotension. In addition, patients with ascites admitted to the hospital for other reasons should also undergo paracentesis to look for evidence of SBP. A low clinical suspicion for SBP does not obviate the need for testing.

• #41 Core Concepts – Recognition and Management of Spontaneous Bacterial Peritonitis – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/spontaneous-bacterial-peritonitis-recognition-management/core-concept/all

  Among persons with ascites who have been followed for a year, spontaneous bacterial peritonitis (SBP) develops in approximately 10 to 30% and has an estimated in-hospital mortality rate of 20%. […] In a person with ascites, the presence of new-onset fever (temperature greater than 37.8C or 100F), abdominal pain, hepatic encephalopathy, metabolic acidosis, renal failure, hypotension, diarrhea, paralytic ileus, hypothermia, leukocytosis, or other signs or symptoms of infection should prompt a diagnostic paracentesis for ascitic fluid analysis and culture. […] Spontaneous bacterial peritonitis refers to infection of the ascitic fluid, as evidenced by an ascitic fluid absolute polymorphonuclear leukocyte (PMN) count of at least 250 cells/mm3 (0.25 109/L), with or without a positive ascitic fluid culture, in the absence of an intra-abdominal surgically treatable source of infection.

• #42 Diagnosis And Treatment For Peritonitis – Klarity Health Library

  https://my.klarity.health/diagnosis-and-treatment-for-peritonitis/

  As mentioned before, inflammation is part of the function of the peritoneum in the process of tissue repair, however, sustained inflammation of the structure is known as the condition of peritonitis. This inflammation can be brought about by several causes, and this leads to differing classifications of the condition. […] Primary peritonitis is defined as an infection of the peritoneal cavity, which is not directly related to an intra-abdominal abnormality, such as an abscess or mass. The condition is also known as spontaneous bacterial peritonitis (SBP), as it predominantly occurs in the ascitic fluid, which occurs usually as a result of an underlying health condition such as cirrhosis of the liver. […] Secondary peritonitis describes the condition when the infection is directly caused by a spillage from either the gastrointestinal or urogenital tracts, which results in contamination of the peritoneum. This type of peritonitis is more commonly observed as there are many potential causes for the abdominal perforation including: anastomotic leak, which occurs following surgery when sections of visceral organs have not been properly resealed, ischemic necrosis, which describes tissue damage due to a loss of blood flow, and direct injury to the abdominal organs.

• #43 Peritonitis: Causes, Diagnosis and Treatment – Nova Science Publishers

  https://novapublishers.com/shop/peritonitis-causes-diagnosis-and-treatment/

  This book contains three chapters about peritonitis, which is an inflammation of the membrane lining the abdominal wall and covering the abdominal organs. […] Chapter One presents classification of postoperative peritonitis, describes symptoms, reviews the current understanding of the phases and stages of development and features of the disease, and discusses the usefulness of different prognostic scales for assessment of complicated intra-abdominal infections. […] Chapter Three discusses in detail different types of peritoneum infections, including their principles of diagnosis and treatment options. […] Chapter 3. Secondary Peritonitis: Causes, Diagnosis and Treatment.

• #44 Diagnosis And Treatment For Peritonitis – Klarity Health Library

  https://my.klarity.health/diagnosis-and-treatment-for-peritonitis/

  Following on from secondary peritonitis, there is also a third condition which can describe a later stage of peritonitis. This is known as tertiary peritonitis and it requires two conditions for its diagnosis: an intra-abdominal infection that persists or recurs for over 48 hours, following a successful and adequate surgical intervention. […] As mentioned in the diagnosis criteria for tertiary peritonitis, the condition can only be reached following a surgical intervention to treat the initial primary or secondary peritonitis. Thus, a surgical route is often undertaken to treat peritonitis, particularly in secondary peritonitis cases. […] Antibiotic therapy is an intervention that can be opted for alongside surgical management but also independently of it, however the course, strength and type of antibiotic treatment can greatly vary and should be tailored based on the cause of peritonitis and the symptoms presented.

• #45 Recent advances in novel diagnostic testing for peritoneal dialysis-related peritonitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8995487/

  Based on the International Society for Peritoneal Dialysis (ISPD) guidelines, diagnosis of peritonitis is made when two of the three following criteria are met: 1) clinical features consistent with peritonitis (e.g., abdominal pain, cloudy dialysis effluent); 2) dialysis effluent white blood cell (WBC) count of 100 cells/L or 0.1 109 cells/L (after a dwell time of at least 2 hours), with 50% polymorphonuclear leukocytes (PMNs); and 3) positive effluent culture. […] However, early and accurate diagnosis can still be a challenge because symptoms can be vague and the investigation results may not be readily available (e.g., during out-of-hours). Furthermore, the PD effluent culture may not always identify the causative organisms and is culture-negative, ultimately affecting the guidance of choosing an effective antibiotic overall.

• #46 Recent advances in novel diagnostic testing for peritoneal dialysis-related peritonitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8995487/

  Because of the risk and the clinical impact of the delay in initiating antibiotics for peritonitis, the ISPD currently recommends that empirical treatment be started as soon as peritonitis is suspected. […] There have been some improvements in the timeliness and accuracy of diagnosing peritonitis over the years. In this review, three aspects of these novel diagnostic tests will be reviewed: confirmation of the diagnosis, identification of the causative pathogens, and risk stratification of treatment response. Overall, this article will discuss the latest evidence and updates for these important unmet needs in the management of PD-related peritonitis.

• #47 Recent advances in novel diagnostic testing for peritoneal dialysis-related peritonitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8995487/

  Peritoneal dialysis-related peritonitis remains a significant complication and an important cause of technique failure. Based on current International Society for Peritoneal Dialysis guidelines, diagnosis of peritonitis is made when two of the three following criteria are met: 1) clinical features consistent with peritonitis; 2) dialysis effluent white blood cell count of 100 cells/L; 3) positive effluent culture. […] However, early and accurate diagnosis can still be faulty, and emphasis has been placed on improving the timeliness and accuracy of diagnosis to facilitate early effective treatment. There have been advances in the novel diagnostic tests such as point-of-care molecular tests, genetics sequencing, mass spectrometry, and machine learning algorithm with immune fingerprinting. This article will discuss the latest evidence and updates of these tests in the management of peritoneal dialysis-related peritonitis.

• #48 Recent advances in novel diagnostic testing for peritoneal dialysis-related peritonitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8995487/

  Peritoneal dialysis-related peritonitis remains a significant complication and an important cause of technique failure. Based on current International Society for Peritoneal Dialysis guidelines, diagnosis of peritonitis is made when two of the three following criteria are met: 1) clinical features consistent with peritonitis; 2) dialysis effluent white blood cell count of 100 cells/L; 3) positive effluent culture. […] However, early and accurate diagnosis can still be faulty, and emphasis has been placed on improving the timeliness and accuracy of diagnosis to facilitate early effective treatment. There have been advances in the novel diagnostic tests such as point-of-care molecular tests, genetics sequencing, mass spectrometry, and machine learning algorithm with immune fingerprinting. This article will discuss the latest evidence and updates of these tests in the management of peritoneal dialysis-related peritonitis.

• #49 Recent advances in novel diagnostic testing for peritoneal dialysis-related peritonitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8995487/

  Peritoneal dialysis-related peritonitis remains a significant complication and an important cause of technique failure. Based on current International Society for Peritoneal Dialysis guidelines, diagnosis of peritonitis is made when two of the three following criteria are met: 1) clinical features consistent with peritonitis; 2) dialysis effluent white blood cell count of 100 cells/L; 3) positive effluent culture. […] However, early and accurate diagnosis can still be faulty, and emphasis has been placed on improving the timeliness and accuracy of diagnosis to facilitate early effective treatment. There have been advances in the novel diagnostic tests such as point-of-care molecular tests, genetics sequencing, mass spectrometry, and machine learning algorithm with immune fingerprinting. This article will discuss the latest evidence and updates of these tests in the management of peritoneal dialysis-related peritonitis.

• #50 Recent advances in novel diagnostic testing for peritoneal dialysis-related peritonitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8995487/

  Peritoneal dialysis-related peritonitis remains a significant complication and an important cause of technique failure. Based on current International Society for Peritoneal Dialysis guidelines, diagnosis of peritonitis is made when two of the three following criteria are met: 1) clinical features consistent with peritonitis; 2) dialysis effluent white blood cell count of 100 cells/L; 3) positive effluent culture. […] However, early and accurate diagnosis can still be faulty, and emphasis has been placed on improving the timeliness and accuracy of diagnosis to facilitate early effective treatment. There have been advances in the novel diagnostic tests such as point-of-care molecular tests, genetics sequencing, mass spectrometry, and machine learning algorithm with immune fingerprinting. This article will discuss the latest evidence and updates of these tests in the management of peritoneal dialysis-related peritonitis.

• #51 Spontaneous Bacterial Peritonitis (SBP) – EMCrit Project

  https://emcrit.org/ibcc/sbp/

  Ascitic fluid cultures are often negative, so SBP may be diagnosed without microbiological proof of infection. […] This is defined as an ascitic fluid culture positive for a single organism, yet the neutrophil count is 250/mm3. […] Guidelines recommend that patients should not receive antibiotics, since most cases are either due to contamination or may self-resolve over time. Repeat paracentesis should be performed to investigate for progression to SBP.(33942342) […] If the neutrophil count doesn’t decrease by at least 25%, this carries a substantial likelihood of treatment failure.(29653741) […] Re-consider the possibility of secondary bacterial peritonitis (and consider a CT scan of the abdomen/pelvis).(33942342)

• #52 Spontaneous bacterial peritonitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/793

  Spontaneous bacterial peritonitis (SBP) is one of the most frequently encountered bacterial infections in patients with cirrhosis, and most commonly seen in patients with end-stage liver disease. […] SBP is diagnosed by an ascitic fluid absolute neutrophil count 250 cells/mm, in the absence of an intra-abdominal surgically treatable source of infection. Positive blood cultures confirm the diagnosis. […] Ascitic fluid laboratory tests should include cell count and culture. […] Diagnostic tests include CBC, serum creatinine, LFT, prothrombin time/INR, blood cultures, ascitic fluid appearance, ascitic fluid absolute neutrophil count (ANC), ascitic fluid culture, and ascitic fluid protein, glucose, lactate dehydrogenase (LDH), pH. […] Emerging tests include highly-sensitive leukocyte esterase reagent strip testing of ascitic fluid (Periscreen) and bedside (standard urine) leukocyte esterase reagent strip testing of ascitic fluid.

• #53 RenoTact® – Detact Diagnostics

  https://www.detactdiagnostics.com/products/renotact/

  Peritoneal Dialysis (PD) patients are at risk of peritonitis, a severe infection that can lead to treatment failure and increased mortality. Current detection methods rely on measuring a host response and slow culture methods, delaying potentially life-saving interventions. […] RenoTact is a rapid, user-friendly test that directly detects causative agents of peritonitis in PD patients. By enabling earlier medical diagnosis and intervention than standard of care methods, RenoTact provides a tool to support patients to continue peritoneal dialysis (PD) without transitioning to hemodialysis (HD), preserving their quality of life and treatment independence. […] RenoTact rapidly identifies viable PD-related Peritonitis infections. […] Provides clinicians actionable data to shorten the time to diagnosis and treatment initiation, decreasing emergency interventions.

• #54 Utilizing Optical Interrogation Methods for Early Diagnosis of Peritonitis in Peritoneal Dialysis Patients – KidneyX

  https://www.kidneyx.org/prize-winners/early-peritonitis-detection-methods/

  Our team aims to design a way to detect peritonitis before patient awareness for those who are using PD in order to treat the infection earlier. […] Our solution, the OpticLine, seamlessly integrates within the current PD setup, connecting in series with the drain lines used. […] OpticLine will use spectrophotometry to analyze the optical density (OD) of WBCs in the dialysis waste fluid as a way to gauge for infection. […] Our results from our works-like spectrophotometer prototype experiment indicate that we detect a significant difference in optical density between our two WBC concentrations of interest: 10 WBC/mm 3 (normal) and 1000 WBC/mm 3 (infected) (p-value = 1.47E-07).

• #55 Diagnosis and management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/90/4/209

  All patients with new-onset ascites, worsening distention, symptoms concerning for spontaneous bacterial peritonitis, or admitted to hospital, should undergo diagnostic paracentesis. […] Clinical deterioration (ie, jaundice, altered mentation, or acute kidney injury) should prompt exclusion of SBP with a diagnostic paracentesis. In hospitalized patients, diagnostic paracentesis should be performed even in the absence of symptoms suggestive of SBP. […] Diagnosis of SBP is established when the fluid absolute neutrophil count is greater than 250 cells/ mm3 and is further confirmed with positive cultures. […] Empiric intravenous antibiotics after cultures are obtained are the mainstay of management of SBP and spontaneous bacterial empyema, as each hours delay in treatment increases mortality by 10%.

• #56 Diagnosis and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome

  https://consultqd.clevelandclinic.org/diagnosis-and-management-of-ascites-spontaneous-bacterial-peritonitis-and-hepatorenal-syndrome

  Development of ascites is associated with a reduction of 5-year survival from 80% to 30%, largely associated with complications that include infection and hepatorenal syndrome. A thorough evaluation is required for diagnosis of new ascites to exclude other etiologies, including heart failure, renal failure, infections or malignancy. Complete initial analysis should consist of laboratory evaluation, abdominal Doppler ultrasonography and a diagnostic paracentesis, although no data currently support this recommendation. In addition to patients with symptoms suggestive of infection (e.g., fevers, abdominal pain), ascitic fluid cultures should be obtained for any decompensating patient, including for the development of encephalopathy, acute kidney injury or jaundice. […] The most common source of bacterial infection in patients with cirrhosis is spontaneous bacterial peritonitis (SBP), accounting for 27% to 36% of infections. Clinical deterioration (i.e., jaundice, altered mentation, or acute kidney injury) should prompt exclusion of SBP with a diagnostic paracentesis. In hospitalized patients, diagnostic paracentesis should be performed even in the absence of symptoms suggestive of SBP. Diagnosis of SBP is established when the fluid absolute neutrophil count is greater than 250 cells/ mm3 and is further confirmed with positive cultures. Empiric intravenous antibiotics after cultures are obtained are the mainstay of management of SBP and spontaneous bacterial empyema, as each hours delay in treatment increases mortality by 10%.

• #57 Spontaneous bacterial peritonitis in adults: Diagnosis – UpToDate

  https://www.uptodate.com/contents/spontaneous-bacterial-peritonitis-in-adults-diagnosis

  Paracentesis should be carried out promptly in patients with suspected SBP, as delays in performing paracentesis have been associated with increased mortality. […] The importance of paracentesis was demonstrated in a review of a database of 17,711 patients with cirrhosis and ascites who were admitted to the hospital with a primary diagnosis of ascites or encephalopathy. Paracentesis was performed in 61 percent. Patients who underwent paracentesis had a lower in-hospital mortality rate than those who did not undergo paracentesis.

• #58 Core Concepts – Recognition and Management of Spontaneous Bacterial Peritonitis – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/spontaneous-bacterial-peritonitis-recognition-management/core-concept/all

  Follow-up ascitic fluid analysis 48 hours after initiating antibiotic therapy is recommended. If the ascitic fluid PMN count has not declined by at least 25% after two days of antibiotic therapy, then the antibiotic coverage needs to be broadened to cover resistant organisms, and secondary bacterial peritonitis needs to be considered. […] Most episodes of SBP are thought to result from bacterial translocation from the gut. […] After a primary episode of SBP, the recurrence rate at one year is approximately 70%, with a 1-year overall survival rate of 30 to 50% among persons who do not receive antibiotic prophylaxis. […] Individuals with cirrhosis and ascites who are admitted to the hospital should undergo diagnostic paracentesis to evaluate for SBP, even in the absence of signs or symptoms of infection.

• #59 Core Concepts – Recognition and Management of Spontaneous Bacterial Peritonitis – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/spontaneous-bacterial-peritonitis-recognition-management/core-concept/all

  Follow-up ascitic fluid analysis 48 hours after initiating antibiotic therapy is recommended. If the ascitic fluid PMN count has not declined by at least 25% after two days of antibiotic therapy, then the antibiotic coverage needs to be broadened to cover resistant organisms, and secondary bacterial peritonitis needs to be considered. […] Most episodes of SBP are thought to result from bacterial translocation from the gut. […] After a primary episode of SBP, the recurrence rate at one year is approximately 70%, with a 1-year overall survival rate of 30 to 50% among persons who do not receive antibiotic prophylaxis. […] Individuals with cirrhosis and ascites who are admitted to the hospital should undergo diagnostic paracentesis to evaluate for SBP, even in the absence of signs or symptoms of infection.

• #60 Peritonitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7152366/

  In addition to the presence of bacteria and a high nucleated cell count with the presence of degenerate neutrophils, the glucose concentration of abdominal effusion is a useful predictor of bacterial peritonitis in dogs. […] The presence of intracellular bacteria, plant material/GI ingesta with associated inflammation, and/or free biliary crystals supports the diagnosis of peritonitis. […] The goals for animals with septic peritonitis are to identify and address the source of contamination to resolve the infection and treat the systemic consequences as quickly as possible. […] Broad-spectrum antimicrobial therapy should be initiated immediately after confirming the diagnosis of septic peritonitis. […] The goals of surgical treatment for patients with septic peritonitis include resolving the cause of the infection, diminishing the infectious and foreign material load, and promoting patient recovery with aggressive supportive care and nutritional supplementation, if indicated. […] The prognosis for animals with peritonitis depends on the underlying cause and whether infection is present.

• #61 Diagnosis and management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/90/4/209

  Effective empiric antibiotic choice plays a key role in timely management of SBP. […] Primary SBP prophylaxis should also be considered in the following cases of cirrhosis without bleeding: Ascitic protein 1.5 g/L, Renal dysfunction (serum creatinine 1.2 mg/ dL, blood urea nitrogen 25 mmol/L, or serum sodium 130 mEq/L), Liver failure, with a Child-Turcotte-Pugh mortality predicting score greater than 9.

• #62 Core Concepts – Recognition and Management of Spontaneous Bacterial Peritonitis – Management of Cirrhosis-Related Complications – Hepatitis C Online

  https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/spontaneous-bacterial-peritonitis-recognition-management/core-concept/all

  Follow-up ascitic fluid analysis 48 hours after initiating antibiotic therapy is recommended. If the ascitic fluid PMN count has not declined by at least 25% after two days of antibiotic therapy, then the antibiotic coverage needs to be broadened to cover resistant organisms, and secondary bacterial peritonitis needs to be considered. […] Most episodes of SBP are thought to result from bacterial translocation from the gut. […] After a primary episode of SBP, the recurrence rate at one year is approximately 70%, with a 1-year overall survival rate of 30 to 50% among persons who do not receive antibiotic prophylaxis. […] Individuals with cirrhosis and ascites who are admitted to the hospital should undergo diagnostic paracentesis to evaluate for SBP, even in the absence of signs or symptoms of infection.

• #63 Recent advances in novel diagnostic testing for peritoneal dialysis-related peritonitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8995487/

  Peritoneal dialysis-related peritonitis remains a significant complication and an important cause of technique failure. Based on current International Society for Peritoneal Dialysis guidelines, diagnosis of peritonitis is made when two of the three following criteria are met: 1) clinical features consistent with peritonitis; 2) dialysis effluent white blood cell count of 100 cells/L; 3) positive effluent culture. […] However, early and accurate diagnosis can still be faulty, and emphasis has been placed on improving the timeliness and accuracy of diagnosis to facilitate early effective treatment. There have been advances in the novel diagnostic tests such as point-of-care molecular tests, genetics sequencing, mass spectrometry, and machine learning algorithm with immune fingerprinting. This article will discuss the latest evidence and updates of these tests in the management of peritoneal dialysis-related peritonitis.

• #64 Peritonitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peritonitis/symptoms-causes/syc-20376247

  Peritonitis can be life-threatening if you don’t get treatment quickly. […] It’s important to get treatment fast for peritonitis. Health care providers have ways to clear out the infection. […] Peritonitis that happens without a hole or tear is called spontaneous bacterial peritonitis. […] Your health care provider may prescribe antibiotics to prevent peritonitis, especially if you’ve had peritonitis before. […] Peritonitis can happen in people who get this treatment. […] Peritonitis may cause a whole-body infection called sepsis.

• #65 Editor’s Pick: Peritonitis in Peritoneal Dialysis Patients: The Case for Rapid Diagnosis, Targeted Treatment, and Monitoring to Improve Outcomes – European Medical Journal

  https://www.emjreviews.com/nephrology/article/editors-pick-peritonitis-in-peritoneal-dialysis-patients-the-case-for-rapid-diagnosis-targeted-treatment-and-monitoring-to-improve-outcomes/

  While improved diagnostic tools are clearly essential and have demonstrated promise in controlled situations with small cohorts, the majority of patients who develop peritonitis receive effective antimicrobial therapy. […] To alter these outcomes, detection must be improved to provide more rapid and targeted treatment, and, even more importantly, understanding of the host responses to different types of infection needs to be improved. […] This knowledge will guide more rapid and effective interventions and lead to an increase in patient and clinician confidence in PD as a therapy through achieving better membrane preservation and long-term outcomes.

• #66 Peritonitis-an Overview – Bezmialem Science

  https://bezmialemscience.org/articles/peritonitis-an-overview/doi/bas.galenos.94695

  In this issue, I will make an overview of peritonitis and its classification, which is a common issue in emergency services and causes mortality if the diagnosis is delayed. […] Peritonitis describes the inflammatory process of the peritoneum, which is usually due to infection, but peritonitis can also be a sterile process. […] Diagnosis of ascitic fluid infection is based on clinical suspicion and analysis of ascitic fluid, particularly white cell count and culture in blood culture bottles. […] The diagnosis is mostly made with imaging methods such as ultrasonography, computed tomography and MRI. Abdominal paracentesis may be helpful in undiagnosed cases. […] Today the gold standard for diagnosis is diagnostic laparoscopy. Since laparoscopy allows treatment as well as diagnosis, it should be performed on patients who cannot be diagnosed with imaging methods. […] In conclusion, it should not be forgotten that early diagnosis of peritonitis is life-saving. Diagnosis will enable us to determine which type of peritonitis it is and ultimately plan the most effective treatment method.

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