Definition and classification of peritonitis sciencedirect. It is usually the endresult of a severe kidney or liver disease. On the other hand, in cases of acute bacterial endocarditis, the organism can colonize on the healthy heart valve, causing the disease. Among patients with ascites who have been followed for a year, spontaneous bacterial peritonitis sbp develops in approximately 10 to 30% and has an. Spontaneous bacterial peritonitis sbp hepatic and biliary. Sbp diagnosis is based on testing of the ascitic fluid obtained by paracentesis. Diagnostic of spontaneous bacterial peritonitis full. Figure 2 shows the results for leukocytes in the dialysate remaining at the end of the dwell. Peritonitis is inflammation of the peritoneum a silklike membrane that lines your inner abdominal wall and covers the organs within your abdomen that is usually due to a bacterial or fungal infection. Causative agents and outcome of spontaneous bacterial peritonitis. Subacute bacterial endocarditis and subsequent shunt. Spontaneous peritonitis is an infection of the peritoneal abdominal cavity. Acute respiratory distress syndrome can develop rapidly.
The fluid buildup often occurs with advanced liver or kidney disease. The perforation of the small intestine caused by the inflammation and necrosis of the intestine, such as in typhoid fever and mesenteric ischemia secondary to the intestinal obstruction, occurs initially as a paralytic ileus, with. Spontaneous bacterial peritonitis sbp is an infection of ascitic fluid that cannot be attributed to any intraabdominal, ongoing inflammatory, or surgically correctable condition. Treatment is with cefotaxime or another antibiotic. Oct 15, 2010 relevant investigations were carried out to detect subacute bacterial peritonitis sbp and their clinical and demographic parameters were compared with non sbp cases. Spontaneous bacterial peritonitis sbp spb is an infectiousinflammatory process involving the peritoneum or peritoneal cavity. Spontaneous bacterial peritonitis is a common complication in patients of cirrhosis of liver8. To compare the clinical and biochemical pattern of spontaneous bacterial peritonitis sbp versus non sbp ascites in cirrhotic patients. Nov 26, 2018 spontaneous bacterial peritonitis sbp is an acute bacterial infection of ascitic fluid. Jul 22, 2014 secondary bacterial peritonitis is more sinister and rare twenty times less common than spontaneous bacterial peritonitis. This case series was conducted at medical c ward, ayub teaching hospital, abbottabad, pakistan from 01042008 to 31032009 on 70 consecutive patients of liver cirrhosis.
This causes an inflammatory response, with recruitment of matrix metalloproteinases, and destruction of collagen. Patients with suspected spontaneous bacterial peritonitis sbp and ascitic fluid pmn. Fourteen years after shunt implantation, a 26yearold patient with myelomeningocele, concomitant hydrocephalus and a ventriculoatrial cerebrospinal f. Spontaneous bacterial peritonitis sbp is defined as an ascitic fluid infection without an evident intraabdominal surgically treatable source 1. Intraabdominal infections result in 2 major clinical manifestations. Update on spontaneous bacterial peritonitis scielo colombia. Pdf spontaneous bacterial peritonitis researchgate. Peritonitis can result from any rupture perforation in your abdomen, or as a complication of other medical conditions.
Spontaneous bacterial peritonitis sbp, an infection of ascitic fluid without a definitive intraabdominal source that can be surgically treated, is a common. Primary peritonitis, otherwise known as spontaneous bacterial peritonitis, most commonly occur in patients with cirrhosis and clinically significant ascites. Courtney ae, doherty cc nephrol dial transplant 2006 feb. Spontaneous bacterial peritonitis sbp is defined as the infection of ascitic fluid without any apparent intra abdominal focus of infection in patients of cirrhosis of liver6,7. The causes of peritonitis can be grouped into five categories. In general, subacute ruminal acidosis is caused by ingestion of diets high in rapidly fermentable carbohydrates andor deficient in physically active fiber. It is defined by the presence of 250 polymorphonuclear cells pmnmm3 in ascites in the absence of an intraabdominal source of infection or malignancy. Diagnostic of spontaneous bacterial peritonitis full text.
Peritonitis is usually caused by infection from bacteria or fungi. 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. Out of 70 cirrhotic patients, sbp was found in 26 patients 37. Fulminant sclerosing peritonitis immediately following acute bacterial peritonitis. Peritonitis is the acute or chronic inflammation of the peritoneum, the membrane that lines the abdominal cavity and covers the visceral organs. Subacute bacterial peritonitis sbp in hospitalized cirrhotic patients article pdf available october 2010 with 91 reads how we measure reads. Spontaneous bacterial peritonitis and other infections in. The term spontaneous bacterial peritonitis sbp was coined by harold conn in the early 1970s to describe the infection of ascitic fluid in the absence of any intra. Spontaneous bacterial peritonitissbp is defined as the infection of ascitic fluid without any apparent intra abdominal focus of infection in patients of cirrhosis of liver6,7. Spontaneous bacterial peritonitis sbp is a serious complication that occurs among cirrhotic patients with ascites. Spontaneous bacterial peritonitis sbp is the most frequent infection in advanced cirrhosis. The hole may be caused by a ruptured appendix, stomach. Generally, no source of the infecting agent is easily identifiable, but contamination of dialysate can cause the condition among those receiving peritoneal dialysis pd.
This is infected ascites fluid due to an underlying surgicallytreatable source of infection i. Jul 22, 2019 spontaneous bacterial peritonitis sbp resulting from chronic liver disease or nephritic syndrome with no obvious source of infection is the most common etiology of primary peritonitis. In these patients, the development of spontaneous bacterial peritonitis is associated with a poor long. Bzeizi division of hepatology, department of internal medicine, riyadh, saudi arabia accepted for publication 27 july 2005 summary the peritoneum is one of the most common extrapulmonary sites of tuberculous infection. Subacute ruminal acidosis is most commonly defined as repeatedly occurring prolonged periods of depression of the ruminal ph to values between 5. Pdf subacute bacterial peritonitis sbp in hospitalized. Patients with cirrhosis present an increased susceptibility to bacterial infections, which are the cause of hospital admission in about 10% of patients and are present in about 40% of those admitted for ongoing complications. Select and utilize appropriate antimicrobial therapy for patients with spontaneous bacterial peritonitis. Sep 02, 2010 spontaneous bacterial peritonitis sbp, an infection of ascitic fluid in the absence of localized intraabdominal infection, is one of the main potentially fatal complications of cirrhosis. Subacute bacterial peritonitis sbp in hospitalized. It is critical to distinguish this from spontaneous bacterial peritonitis, because secondary. Oral treatment of subacute bacterial endocarditis in children. It is specifically an infection of the ascitic fluid an increased volume of peritoneal fluid.
Spontaneous bacterial peritonitis symptoms, diagnosis and. Acute abdominal pain gastrointestinal disorders merck. The incidence of bacterial infection is particularly high in patients with advanced cirrhosis andor severe hemorrhage. Spontaneous bacterial peritonitis sbp is present when this tissue becomes infected and there is no clear cause.
Almost 80% of cases result from necrosis of the digestive conduit 14. It can also occur in patients with nephrotic syndrome. The presence of sbp, which almost always occurs in patients with cirrhosis and ascites, is suspected because of signs and symptoms such as fever, abdominal pain, or altered mental status table 1. Spontaneous bacterial peritonitis sbp is defined as an ascitic fluid infection without an evident intraabdominal surgically treatable source.
Ascites is most commonly a complication of cirrhosis of the liver. We observed no significant increase in the number of leukocytes in the dialysate in lpsinduced peritonitis, but a substantial increase was observed. Spontaneous bacterial peritonitis sbp is the most frequent and lifethreatening infection in patients with liver cirrhosis requiring prompt. Guadalupe garciatsao, in goldmans cecil medicine twenty fourth edition, 2012. Recognition and management of spontaneous bacterial. Untreated sbp has a mortality rate of up to 50%, but with prompt diagnosis and treatment of the condition, this figure may be reduced to 20%. Outcomes in patients with spontaneous bacterial peritonitis are poor since acute kidney injury, acuteonchronic liver failure, and death occur in. Spontaneous bacterial peritonitis investigations bmj.
Spontaneous bacterial peritonitis sbp is associated with ascites from patients with cirrhosis highest risk patients for sbp, heart failure, or patients with systemic lupus and nephrosis. White count, ph and lactate in ascites in the diagnosis of. Mdct reveals a large amount of high density fluid in the peritoneal cavity associated with diffuse thickening of peritoneal lining. Diagnosis of subacute bacterial endocarditis can be done by collecting three blood culture specimens over a 24hour period for analysis, also it can usually be indicated by the existence of. Types of acute peritonitis include primary and secondary. Kidney failure, liver failure, and disseminated intravascular. Peritonitis is present when this tissue becomes inflamed or infected. Spontaneous bacterial peritonitis spontaneous bacterial. The mechanism of subacute bacterial endocarditis could be due to malformed stenotic valves which in the company of bacteremia, become infected, via adhesion and subsequent colonization of the surface area. Unlike spontaneous bacterial peritonitis, factors such as impaired opsonization. Subacute bacterial endocarditis caused by cardiobacterium hominis.
Indeed, patients with culturenegative neutrocytic ascites have similar mortality rates as patients with confirmed spontaneous bacterial peritonitis and benefit from antibiotic treatment. Almani et al had 8% 4924 hepatorenal syndrome 26 hepatopulmonary syndrome 42 patients with dcld developed hepatic encephalopathy 33%. In humans, primary peritonitis has also been referred to as spontaneous bacterial peritonitis and most often complicates development of ascites e. Since 1970, when sbp was first described and up to the present, the mortality rate has been decreasing from 80% to 30%, due to. Management of peritonitis in the critically ill patient. Peritonitis causes fluid to shift into the peritoneal cavity and bowel, leading to severe dehydration and electrolyte disturbances. Sbp is most often caused by infection in fluid that collects in the peritoneal cavity ascites. Chapter 91 ascites and spontaneous bacterial peritonitis 1519 than usual i. The topic acute generalized peritonitis you are seeking is a synonym, or alternative name, or is closely related to the medical condition spontaneous peritonitis. Spontaneous bacterial peritonitis in patients with cirrhosis. The mortality rate from primary spontaneous peritonitis is about 10% and the mortality rate from secondary peritonitis is less than 5%. Dec 12, 2006 sbp variants and secondary bacterial peritonitis.
Diagnosis of spontaneous bacterial peritonitis indications for testing in a patient with ascites, the presence of newonset fever temperature greater than 37. Hepatic encephalopathy 09 1019 2029 3039 98% 92% 78% 40% 93% 86% 71% 37% scoring 6month survival 12month survival. Tbp is a subacute disease and its symptoms evolve over a period of several weeks to months. Mattioli summary peritonitis is defined as the inflammation of the peritoneum or of a part thereof, which may not necessarily be due to infection. Inflammation, leukocytes, permeability, peritonitis, protein loss introduction the development of animal models with direct relevance to peritoneal dialysis pd patients is a major acute peritonitis in a c57bl6 mouse model of john k. There is no evidence of free air or leak of oral contrast material.
Spontaneous bacterial peritonitis sbp, an infection of ascitic fluid in the absence of localized intraabdominal infection, is one of the main potentially fatal complications of cirrhosis. Acute peritonitis is an inflammatory process within the peritoneal cavity most commonly caused by a bacterial infection. It is either caused by bacteria or chemicals, can either be primary or secondary, and acute or chronic. Subacute bacterial endocarditis associated with upper endoscopy. Sep 24, 2010 patients with cirrhosis present an increased susceptibility to bacterial infections, which are the cause of hospital admission in about 10% of patients and are present in about 40% of those admitted for ongoing complications. Spontaneous bacterial peritonitis sbp is the development of a bacterial infection in the peritoneum, despite the absence of an obvious source for the infection. Secondary peritonitis is when another condition is the cause. It is a major cause of the high rates of mortality. Wed like to understand how you use our websites in order to improve them.
Spontaneous bacterial peritonitis occurs in both children and adults and is a wellknown and ominous complication in patients with cirrhosis. Subacute bacterial peritonitis cirrhosis in only 1 patient i. The following is a list of these categories and some examples of their causes. Of patients with cirrhosis who have spontaneous bacterial peritonitis, 70% are childpugh class c. This is the most common type of acute intraabdominal.
If haemorrhagic ascites is present, subtract 1 neutrophil for every 250 rbcs. Pdf on oct 1, 1998, j such and others published spontaneous bacterial peritonitis find, read and cite all the research you need on. Peritoneum is a membrane that covers the surface of both the organs that lie in the abdominal cavity and the inner surface of the abdominal cavity itself. Inflammation may extend throughout the peritoneum or may be localized as an abscess. Spontaneous bacterial peritonitis journal of gastrointestinal and. Bacterial infection, including sbp, is a major problem in patients with cirrhosis and acute gastrointestinal hemorrhage, occurring in between 25% and 65% of patients with gastrointestinal bleeding. Differentiate spontaneous bacterial peritonitis from secondary bacterial peritonitis. Four of them had wbc greater than 1,000 per mm3 and pmn greater than 500 per mm3. Spontaneous bacterial peritonitis occurs primarily in patients with cirrhosis and ascites. Pdf subacute bacterial endocarditis associated with upper. It is one of the most frequently encountered bacterial infections in patients with cirrhosis. Recognition and management of spontaneous bacterial peritonitis. Lastly, about a third of patients develop nosocomial infections. The spontaneous bacterial infections that commonly occur in the setting of advanced liver disease include spontaneous bacterial peritonitis sbp and spontaneous bacteremia sb.
Secondary bacterial peritonitis is more sinister and rare twenty times less common than spontaneous bacterial peritonitis. Manifestations may include fever, malaise, and symptoms of ascites and worsening hepatic failure. Spontaneous bacterial peritonitis sbp is the most frequent and lifethreatening infection in patients with liver cirrhosis requiring prompt recognition and treatment. Easl clinical practice guidelines on the management of ascites. Peritonitis commonly decreases intestinal motility and causes intestinal distention with gas. Pdf subacute bacterial endocarditis associated with. Spontaneous bacterial peritonitis, an infection of ascitic fluid, occurs in the absence of perforation of a hollow viscus or an intraabdominal inflammatory focus such as an abscess, acute pancreatitis, or cholecystitis. Peritonitis pearihtuhnyetis infection, or rarely some other type of inflammation, of the peritoneum. Patients with suspected spontaneous bacterial peritonitis sbp and ascitic fluid pmn greater than or equal to 250 cellsmm 3 0. Sbp can occur in cirrhotic patients or secondary to bowel perforation, gastrointestinal infections, tb, trauma, surgery etc.
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