Secondary peritonitis laboratory tests: Difference between revisions
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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.<ref name="pmid3518442">{{cite journal| author=Runyon BA| title=Bacterial peritonitis secondary to a perinephric abscess. Case report and differentiation from spontaneous bacterial peritonitis. | journal=Am J Med | year= 1986 | volume= 80 | issue= 5 | pages= 997-8 | pmid=3518442 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3518442 }} </ref> | 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.<ref name="pmid3518442">{{cite journal| author=Runyon BA| title=Bacterial peritonitis secondary to a perinephric abscess. Case report and differentiation from spontaneous bacterial peritonitis. | journal=Am J Med | year= 1986 | volume= 80 | issue= 5 | pages= 997-8 | pmid=3518442 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3518442 }} </ref> | ||
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{{familytree | boxstyle=background: #FFF0F5; color: #000000;| | | A01 | | A01='''Patients with signs and symptoms suggestive of peritonitis:'''<br> | |||
* Abdominal pain +/- guarding or rebound | |||
* Fever, leukocytosis | |||
* Signs of sepsis (hypotension, tachycardia) | |||
{{familytree | | | |!| |}} | |||
{{familytree | boxstyle=background: #FFF0F5; color: #000000;| | | B01 | | B01='''Suspicion of secondary peritonitis''' | |||
{{familytree | | | |!| |}} | |||
{{familytree | boxstyle=background: #FFF0F5; color: #000000;| | | C01 | | C01=No air on flat and upright abdominal films | |||
{{familytree | | | |!| |}} | |||
{{familytree | boxstyle=background: #FFF0F5; color: #000000;| | | D01 | | D01='''Continue work up for''':<br> | |||
* Cholecystitis, Pancreatitis, Appendicitis | |||
* Diverticulitis, Colitis | |||
* PID | |||
* | |||
==References== | ==References== | ||
Revision as of 22:01, 6 February 2017
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Secondary Peritonitis Microchapters |
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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 Tests
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.[4] 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:[4]
- 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.[5]
{{familytree | boxstyle=background: #FFF0F5; color: #000000;| | | A01 | | A01=Patients with signs and symptoms suggestive of peritonitis:
{{familytree | boxstyle=background: #FFF0F5; color: #000000;| | | B01 | | B01=Suspicion of secondary peritonitis {{familytree | boxstyle=background: #FFF0F5; color: #000000;| | | C01 | | C01=No air on flat and upright abdominal films {{familytree | boxstyle=background: #FFF0F5; color: #000000;| | | D01 | | D01=Continue work up for:
References
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