Spontaneous bacterial peritonitis differential diagnosis
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Differentiating Spontaneous bacterial peritonitis from other Diseases |
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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. [1]
| Classification of acute abdomen
based on the etiology |
Presentation | 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 | ||||||||||||||
| Common causes of peritonitis | Primary peritonitis | Spontaneous bacterial peritonitis | Motionless | ✔ | ✔ | ✔ | ✔ | ✔ | Absent (late) | |||||||||||||
| Secondary peritonitis | Acute cholecystitis | Murphy sign | ✔ | Ultrasound | ||||||||||||||||||
| Acute diverticulitis | ✔ | CT scan | ||||||||||||||||||||
| Acute pancreatitis | Serum amylase/lipase | CT scan | ||||||||||||||||||||
| Acute appendicitis | ✔ | CT scan, ultrasound | ||||||||||||||||||||
| Acute cholangitis | ||||||||||||||||||||||
| Acute salpingitis | ||||||||||||||||||||||
| Perforated gastro-duodenal ulcers | Loss of liver dullness due to free air accumulating under the diaphragm | Scaphoid, tense abdomen | ✔ | Diminished (late) | CT scan | |||||||||||||||||
| Small and large bowel perforations | ||||||||||||||||||||||
| Obstruction | Small intestinal obstruction | Dissension of the abdomen | Hyper peristalsis
(early) Visible peristalsis / quiet abdomen (late) |
Flat and upright film, CT scan | ||||||||||||||||||
| Paralytic ileus | Distension/ soft doughy fullness | ✘ | Minimally heard | |||||||||||||||||||
| Vascular disorders | Ischemic | Mesenteric ischemia | Soft duffy fullness | Severe pain out of proportion to examination | CT Angiogram, MRI | |||||||||||||||||
| Acute ischemic colitis | CT scan,
Colonoscopy |
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| Hemorrhagic | Ruptured abdominal aortic aneurysm | |||||||||||||||||||||
| Intraabdominal or Retroperitoneal hemorrhage | ||||||||||||||||||||||
References
- ↑ Wu, Hongli; Chen, Lin; Sun, Yuefeng; Meng, Chao; Hou, Wei (2016). "The role of serum procalcitonin and C-reactive protein levelsin predicting spontaneous bacterial peritonitis in patients with advanced liver cirrhosis". Pakistan Journal of Medical Sciences. 32 (6). doi:10.12669/pjms.326.10995. ISSN 1681-715X.