Peritonitis risk factors: Difference between revisions

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Latest revision as of 14:47, 30 January 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]

Overview

Common risk factors for peritonitis in the development of peritonitis include liver disease, dialysis, and abdominal trauma.^[1]

Risk Factors

The following factors may increase the risk of peritonitis:

Penetrating trauma to the intestine
Twisted intestine
Inflammation of the hollow viscera of the abdomen
Surgical injuries to the abdominal viscera
Liver disease (Cirrhosis)
Pelvic inflammatory disease
Leakage of sterile body fluids into the peritoneum, such as blood (endometriosis), gastric acid (peptic ulcer), bile( liver biopsy), urine(pelvic trauma), menstruum( salpingitis),pancreatic juice (pancreatitis).
Peritoneal dialysis
Extra peritoneal tuberculous infection

Biochemical risk factors

Well-established risk factors for developing an initial episode of SBP are :

Low ascitic fluid protein level (<1 g/dL)^[2]
Elevated serum bilirubin level (>4 mg/dL)
Advanced Cirrhosis
Low levels of 25-hydroxy vitamin D
Serum albumin level <2.85 g/dL

Clinical risk factors

Patients with Vatical hemorrhage and GI bleeding associated with Cirrhosis are more prone to develop SBP irrespective of the presence of ascites.

Genetic risk factors

The Toll-like receptor 2 (TLR2) proteins^[3] variants of the NOD2 (nucleotide-binding oligomerisation domain containing gene and Farnesoid X were known to cause SBP.

Pharmacological risk factors

Proton pump inhibitors (PPI) has been associated with a three-fold increase in the risk and identified as an independent risk factor for SBP in patients with advanced cirrhosis.
Beta-adrenergic antagonists namely nonselective beta-blocker (NSBB) therapy was found to be protective for SBP.

Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites.^[4]

Low serum sodium levels
Child-Pugh stage C
Elevated ascites PMN counts (≥100 cells/μl)
MELD≥22
Elevated CRP levels

Common risk factors for peritonitis are described as follows:^[5]

Primary Peritonitis	Secondary Peritonitis	Tertiary Peritonitis
Cirrhosis with ascitis Portal hypertension with ascitis Patient with continuous ambulatory peritoneal dialysis (CAPD)	Ruptured gastric ulcer, appendicular abscess or diverticular abscess Inflamatory bowel diseases such as chron's disease or ulcerative colitis with toxic megacolon Pelvic inflamatory disease Recent surgical procedures Recent trauma to the abdomen (e.g. Stab injury or gun shot injury)	Previous history of severe antibiotic use Treatment failure in patients with primary or secondary peritonitis

References

↑ van Erpecum KJ (2006). "Ascites and spontaneous bacterial peritonitis in patients with liver cirrhosis". Scand J Gastroenterol Suppl (243): 79–84. doi:10.1080/00365520600664342. PMID 16782626.
↑ Mustafa MG, Al Mamun MA, Alam AK (2009). "Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis". Bangladesh Med Res Counc Bull. 35 (2): 41–3. PMID 20120777.
↑ Nischalke HD, Berger C, Aldenhoff K, Thyssen L, Gentemann M, Grünhage F; et al. (2011). "Toll-like receptor (TLR) 2 promoter and intron 2 polymorphisms are associated with increased risk for spontaneous bacterial peritonitis in liver cirrhosis". J Hepatol. 55 (5): 1010–6. doi:10.1016/j.jhep.2011.02.022. PMID 21356257.
↑ Schwabl P, Bucsics T, Soucek K, Mandorfer M, Bota S, Blacky A; et al. (2015). "Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites". Liver Int. 35 (9): 2121–8. doi:10.1111/liv.12795. PMID 25644943.
↑ Li PK, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE et al. (2016) ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int 36 (5):481-508. DOI:10.3747/pdi.2016.00078 PMID: 27282851

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[pmid16782626-1] van Erpecum KJ (2006). "Ascites and spontaneous bacterial peritonitis in patients with liver cirrhosis". Scand J Gastroenterol Suppl (243): 79–84. doi:10.1080/00365520600664342. PMID 16782626.

[pmid20120777-2] Mustafa MG, Al Mamun MA, Alam AK (2009). "Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis". Bangladesh Med Res Counc Bull. 35 (2): 41–3. PMID 20120777.

[pmid21356257-3] Nischalke HD, Berger C, Aldenhoff K, Thyssen L, Gentemann M, Grünhage F; et al. (2011). "Toll-like receptor (TLR) 2 promoter and intron 2 polymorphisms are associated with increased risk for spontaneous bacterial peritonitis in liver cirrhosis". J Hepatol. 55 (5): 1010–6. doi:10.1016/j.jhep.2011.02.022. PMID 21356257.

[pmid25644943-4] Schwabl P, Bucsics T, Soucek K, Mandorfer M, Bota S, Blacky A; et al. (2015). "Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites". Liver Int. 35 (9): 2121–8. doi:10.1111/liv.12795. PMID 25644943.

[pmid27282851-5] Li PK, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE et al. (2016) ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int 36 (5):481-508. DOI:10.3747/pdi.2016.00078 PMID: 27282851

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@@ Line 1: / Line 1: @@
+__NOTOC__
+{{CMG}} {{AE}} {{SCh}}
 {{Peritonitis}}
-{{CMG}}
 ==Overview==
-Patients with liver disease are at increased risk. Risk factors for liver disease include alcoholic [[cirrhosis]] and other diseases that lead to [[cirrhosis]], such as [[viral hepatitis]] ([[Hepatitis B]] or C).
+Common risk factors for peritonitis in the development of peritonitis include liver disease, [[dialysis]], and abdominal trauma.<ref name="pmid16782626">{{cite journal| author=van Erpecum KJ| title=Ascites and spontaneous bacterial peritonitis in patients with liver cirrhosis. | journal=Scand J Gastroenterol Suppl | year= 2006 | volume=  | issue= 243 | pages= 79-84 | pmid=16782626 | doi=10.1080/00365520600664342 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16782626  }} </ref>
-Spontaneous peritonitis also occurs in patients who are on [[dialysis]] for [[kidney failure]].
+==Risk Factors==
-==References==
+The following factors may increase the risk of peritonitis:
-{{reflist|2}}
+* Penetrating trauma to the intestine
+* Twisted intestine
+* Inflammation of the hollow viscera of the abdomen
+* Surgical injuries to the abdominal viscera
+* Liver disease (Cirrhosis)
+* Pelvic inflammatory disease
+* Leakage of sterile body fluids into the peritoneum, such as blood (endometriosis), gastric acid (peptic ulcer), bile( liver biopsy), urine(pelvic trauma), menstruum( salpingitis),pancreatic juice (pancreatitis).
+* Peritoneal dialysis
+* Extra peritoneal tuberculous infection
+=== Biochemical risk factors ===
+''Well-established risk factors for developing an initial episode of SBP are'' :
+* Low ascitic fluid protein level (<1 g/dL)<ref name="pmid20120777">{{cite journal| author=Mustafa MG, Al Mamun MA, Alam AK| title=Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis. | journal=Bangladesh Med Res Counc Bull | year= 2009 | volume= 35 | issue= 2 | pages= 41-3 | pmid=20120777 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20120777  }} </ref>
+* Elevated serum bilirubin level (>4 mg/dL)
+* Advanced Cirrhosis
+* Low levels of 25-hydroxy vitamin D
+* Serum albumin level <2.85 g/dL
-{{Gastroenterology}}
+=== Clinical risk factors===
+* Patients with Vatical hemorrhage and GI bleeding associated with Cirrhosis are more prone to develop SBP irrespective of the presence of ascites.
+=== Genetic risk factors===
+* The Toll-like receptor 2 (TLR2) proteins<ref name="pmid21356257">{{cite journal| author=Nischalke HD, Berger C, Aldenhoff K, Thyssen L, Gentemann M, Grünhage F et al.| title=Toll-like receptor (TLR) 2 promoter and intron 2 polymorphisms are associated with increased risk for spontaneous bacterial peritonitis in liver cirrhosis. | journal=J Hepatol | year= 2011 | volume= 55 | issue= 5 | pages= 1010-6 | pmid=21356257 | doi=10.1016/j.jhep.2011.02.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21356257  }} </ref> variants of the NOD2 (nucleotide-binding oligomerisation domain containing gene and Farnesoid X were known to cause SBP.
+=== Pharmacological risk factors===
+* Proton pump inhibitors (PPI) has been associated with a  three-fold increase in the risk and identified as an independent risk factor for SBP in patients with advanced cirrhosis.
+* Beta-adrenergic antagonists namely nonselective beta-blocker (NSBB) therapy was found to be protective for SBP.
-[[Category:Gastroenterology]]
+''Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites''.<ref name="pmid25644943">{{cite journal| author=Schwabl P, Bucsics T, Soucek K, Mandorfer M, Bota S, Blacky A et al.| title=Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites. | journal=Liver Int | year= 2015 | volume= 35 | issue= 9 | pages= 2121-8 | pmid=25644943 | doi=10.1111/liv.12795 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25644943  }} </ref>
-[[Category:Inflammations]]
+* Low serum sodium levels
-[[Category:Diseases involving the fasciae]]
+* Child-Pugh stage C
-[[Category:Medical emergencies]]
+* Elevated ascites PMN counts (≥100 cells/μl)
-[[Category:Surgery]]
+* MELD≥22
-[[Category:Emergency medicine]]
+* Elevated CRP levels
-[[Category:Infectious disease]]
+''Common risk factors for peritonitis are described as follows'':<ref name="pmid27282851">Li PK, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE et al. (2016) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=27282851 ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment.] ''Perit Dial Int'' 36 (5):481-508. [http://dx.doi.org/10.3747/pdi.2016.00078 DOI:10.3747/pdi.2016.00078] PMID: [https://pubmed.gov/27282851 27282851]</ref>
+{| class="wikitable"
+|-
+! style = "width: 33%;" |  '''Primary Peritonitis'''
+! style = "width: 34%;" |  '''Secondary Peritonitis'''
+! style = "width: 33%;" |  '''Tertiary Peritonitis'''
+|-
+| valign = top |
+* Cirrhosis with ascitis
+* Portal hypertension with ascitis
+* Patient with continuous ambulatory peritoneal dialysis (CAPD)
+| valign = top |
+* Ruptured gastric ulcer, appendicular abscess or diverticular abscess
+* Inflamatory bowel diseases such as chron's disease or ulcerative colitis with toxic megacolon
+* Pelvic inflamatory disease
+* Recent surgical procedures
+* Recent trauma to the abdomen (e.g. Stab injury or gun shot injury)
+| valign = top |
+* Previous history of severe antibiotic use
+* Treatment failure in patients with primary or secondary peritonitis
+|}
-[[da:Peritonitis]]
+==References==
-[[de:Peritonitis]]
+{{reflist|2}}
-[[es:Peritonitis]]
-[[fr:Péritonite]]
-[[it:Peritonite]]
-[[nl:Buikvliesontsteking]]
-[[ja:腹膜炎]]
-[[pl:Zapalenie otrzewnej]]
-[[ru:Перитонит]]
-[[fi:Peritoniitti]]
-[[sv:Bukhinneinflammation]]
-[[tr:Periton]]
-{{WikiDoc Help Menu}}
+{{WH}}
-{{WikiDoc Sources}}
+{{WS}}