Spontaneous bacterial peritonitis differential diagnosis

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

Overview

Spontaneous bacterial peritonitis must be differentiated from other diseases that cause fever and abdominal pain, such as peritonitis, pyelonephritis, and appendicitis.

Differentiating Spontaneous bacterial peritonitis from other Diseases

Spontaneous bacterial peritonitis presents as fever and pain in the abdomen. These symptoms may also be seen in other abdominal conditions such as:

• Peritonitis - this presents as abdominal pain with guarding which is seldom seen in spontaneous bacterial peritonitis.
• Pyelonephritis - this presents as pain in the costovertebral angle.
• Appendicitis - this presents with a typical history of radiation of pain from umbilicus to McBurney's point compared to diffuse pain in spontaneous bacterial peritonitis.
• PCT level was higher in advanced Liver cirrhosis patients with SBP than CNNA which indicated it may represent as a simple biomarker for differentiating SBP from CNNA. PCT may be a prognostic predictor to guide the empirical antimicrobial therapy in order to decrease the in-hospital mortality and the frequency of complications.

Classification of acute abdomen based on the etiology	Pathological source of acute abdomen	Age of presentation	Typical History	Localization of the abdominal pain	Symptoms	Specific signs	Physical findings							Diagnostic tests and Lab findings	Choice of Imaging	Medical Treatment	Surgical treatment	Other comments
							Appearance of the patient	Abdominal tenderness	Guard ing	Rigidity	Rebound tenderness	Bowel sounds	Peristalsis
Peritonitis	Spontaneous bacterial peritonitis
	Secondary peritonitis
Inflammation of the abdominal viscera	Cholecystitis
	Diverticulitis
	Pancreatitis
	Appendicitis
Perforation of hollow viscous	Perforated peptic ulcer
Obstruction	Small intestinal obstruction
Paralytic ileus
Vascular disorders	Mesenteric ischemia
	Acute ischemic colitis
	Ruptured abdominal aortic aneurysm
	Intraabdominal or Retroperitoneal hemorrhage

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