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	Treatment	Other comments
							Appearance of the patient/ shape of the abdomen	Abdominal tenderness	Shifting dullness	Rigidity and Guard ing	Deep tenderness	Rebound tenderness	Cough tenderness	Bump tenderness	Bowel sounds
Peritonitis	Spontaneous bacterial peritonitis						Motionless	✔	✔	✔		✔	✔		Absent (late)
	Secondary peritonitis
Inflammation of the abdominal viscera	Cholecystitis					Murphy sign		✔
	Diverticulitis							✔
	Pancreatitis
	Appendicitis							✔
	Cholangitis
Bowel Perforation	Perforated peptic ulcer					Loss of liver dullness due to free air accumulating under the diaphragm	Scaphoid, tense abdomen			✔					Diminished (late)
Obstruction	Small intestinal obstruction						Dissension of the abdomen								Hyper peristalsis (early) Visible peristalsis / quiet abdomen (late)
Paralytic ileus							Distension/ soft doughy fullness	✘							Minimally heard
Vascular disorders	Mesenteric ischemia						Soft duffy fullness	Severe pain out of proportion to examination
	Acute ischemic colitis
	Ruptured abdominal aortic aneurysm
	Intraabdominal or Retroperitoneal hemorrhage

References

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