Spontaneous bacterial peritonitis history and symptoms

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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] Shivani Chaparala M.B.B.S [3]

Overview

The main manifestations of peritonitis are acute abdominal pain, tenderness, and guarding, which are exacerbated by moving the peritoneum, e.g. coughing, flexing the hips, or eliciting the Blumberg sign (a.k.a. rebound tenderness, meaning that pressing a hand on the abdomen elicits pain, but releasing the hand abruptly will aggravate the pain, as the peritoneum snaps back into place)
Symptoms include fevers, chills, nausea, vomiting, abdominal tenderness and general malaise.
Patients may complain of abdominal pain and worsening ascites.
It is important to emphasize, though, that hepatic encephalopathy may be the only manifestation of SBP, especially in people with cirrhosis and ascites.

A directed history should be obtained to ascertain the precipitant of this condition. A detailed history has to be obtained regarding

Worsening of pre-existing ascites and progressive encephalopathy in a patient with cirrhotic ascites

Diffuse, continuous Abdominal pain is the hallmark of peritonitis, although some may be asymptomatic.

Altered mental status may manifest as frank delirium, confusion, or cognitive slowing.

Development of ileus paralyticus (i.e. intestinal paralysis), which also causes nausea and vomiting

Breathlessness may be due to infection, fluid overload or underlying [[heart condition]