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Distinguishing spontaneous from secondary bacterial peritonitis

Distinguishing spontaneous from secondary bacterial peritonitis
Secondary bacterial peritonitis is infected ascites in the setting of an underlying intra-abdominal source of infection. The distinction of spontaneous from secondary bacterial peritonitis is based upon ascitic fluid analysis, imaging studies, and response to treatment. Refer to UpToDate content on the management of spontaneous bacterial peritonitis and secondary bacterial peritonitis.
PMN: polymorphonuclear; LDH: lactate dehydrogenase; CT: computed tomography; IR: interventional radiology.
* The following tests are routinely performed on ascitic fluid when peritonitis is suspected: Gram stain, aerobic and anaerobic culture (ie, in blood culture bottles at the bedside), cell count and differential, albumin, total protein, glucose, LDH, amylase, bilirubin (if the fluid is dark orange or brown).
¶ Bile-stained ascites typically appears dark orange or brown.
Graphic 122552 Version 2.0

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