Secondary peritonitis laboratory tests
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]
Overview
Classic cinical presentaion may not be present in ~30% of patients with infected ascites, and management based on clinical evaluation alone is not definitive in separating secondary peritonitis from other causes of acute abdomen such as spontaneous bacterial peritonitis.[1][2]
Laboratory Findings
As the clinical signs and symptoms is not a good representation for the diagnosis of secondary peritonitis, initial ascitic fluid analysis and the response of ascitic fluid parameters to treatment have been found to be of great value in differentiating secondary peritonitis from spontaneous bacterial peritonitis.[3]
Blood Test
- Complete blood count and differential count are tested to confirm infection
- BUN and serun.creatinine to asses the renal function.
- ABG analysis
- Serum glucose
- Blood culture may be useful in sepsis
- Serum electrolytes
- Liver function tests are to be performed for the evaluation of cirrhosis
- Coagulation profile
- Urine analysis and culture to rule out asymptomatic bacteriuria
- Amylase and Lipase levels to rule out pancreatitis as the cause of ascites
- CRP[4]
- Procalcitonin[5][6][7]
Paracentesis
Routine testing of ascitic fluid analysis included measurement of total protein, albumin, glucose, lactate dehydrogenase, amylase, and PMN count. Ascitic fluid analysis with concentrations of total protein, glucose and LDH were helpful in differentiating secondary peritonitis from SBP.[8] Culture results are too late to be helpful in evaluating the patient at the time of presentation. Thus, chemical analysis or gram stain of ascitic fluid is more useful in the early evidence of perforated viscus.
Diagnostic criteria for peritonitis associated with perforation on the basis of the initial ascitic fluid analysis include fulfilling at least two of the following criteria:[8]
- Total protein > 1 g/dl
- Glucose < 50 mg/dl
- Lactate dehydrogenase (LDH) greater than the upper limit of normal for serum
Non perforated secondary peritonitis such as perinephric abscess, cannot be readily apparent on the basis of the initial ascitic fluid analysis, but the response of the ascitic fluid cell count and cultures to treatment can raise suspicion of this form of secondary peritonitis.[9]
References
- ↑ Hoefs JC, Runyon BA (1985). "Spontaneous bacterial peritonitis". Dis Mon. 31 (9): 1–48. PMID 3899555.
- ↑ Akriviadis EA, Runyon BA (1990). "Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis". Gastroenterology. 98 (1): 127–33. PMID 2293571.
- ↑ Runyon BA, Hoefs JC (1986). "Spontaneous vs secondary bacterial peritonitis. Differentiation by response of ascitic fluid neutrophil count to antimicrobial therapy". Arch Intern Med. 146 (8): 1563–5. PMID 3729637.
- ↑ Mulari K, Leppäniemi A (2004). "Severe secondary peritonitis following gastrointestinal tract perforation". Scand J Surg. 93 (3): 204–8. PMID 15544075.
- ↑ Schröder J, Staubach KH, Zabel P, Stüber F, Kremer B (1999). "Procalcitonin as a marker of severity in septic shock". Langenbecks Arch Surg. 384 (1): 33–8. PMID 10367627.
- ↑ Reith HB, Mittelkötter U, Wagner R, Thiede A (2000). "Procalcitonin (PCT) in patients with abdominal sepsis". Intensive Care Med. 26 Suppl 2: S165–9. doi:10.1007/BF02900731. PMID 18470713.
- ↑ Reith HB, Mittelkötter U, Debus ES, Küssner C, Thiede A (1998). "Procalcitonin in early detection of postoperative complications". Dig Surg. 15 (3): 260–5. PMID 9845596.
- ↑ 8.0 8.1 Runyon BA, Hoefs JC (1984). "Ascitic fluid analysis in the differentiation of spontaneous bacterial peritonitis from gastrointestinal tract perforation into ascitic fluid". Hepatology. 4 (3): 447–50. PMID 6724512.
- ↑ Runyon BA (1986). "Bacterial peritonitis secondary to a perinephric abscess. Case report and differentiation from spontaneous bacterial peritonitis". Am J Med. 80 (5): 997–8. PMID 3518442.