Spontaneous bacterial peritonitis differential diagnosis: Difference between revisions

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Revision as of 17:46, 24 January 2017

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	Symptoms						Signs							Lab findings	Preferred diagnostic test	Additional findings
			Fever	Jaundice	Nausea/ Vomiting	Diarrhea	Constipation	Abdominal Pain Location	General Appearance	Bowel Sounds	Abdominal tenderness		Shifting dullness	Rigidity	Rebound tenderness
			Fever	Jaundice	Nausea/ Vomiting	Diarrhea	Constipation	Abdominal Pain Location	General Appearance	Bowel Sounds	Superficial	Deep	Shifting dullness	Rigidity	Rebound tenderness
Common causes of peritonitis	Primary peritonitis	Spontaneous bacterial peritonitis							Motionless		✔		✔	✔	✔
	Inflammatory disorders and perforations causing Secondary peritonitis	Perforated gastro-duodenal ulcers							Scaphoid, tense abdomen					✔			CT scan
		Acute cholangitis															Ultrasound, CT, ERCP, MRCP, PTC	Charcot triad ( RUQ pain, jaundice,fever) Reynold pentad ( RUQ pain, jaundice,fever, confusion,shock)
		Acute cholecystitis									✔						Ultrasound
		Acute pancreatitis														Serum amylase/lipase	CT scan
		Acute appendicitis									✔						CT scan, ultrasound
		Small and large bowel perforations
		Acute diverticulitis									✔						CT scan
		Acute salpingitis
Hollow Viscous Obstruction		Intestinal obstruction							Dissension of the abdomen								Flat and upright film, CT scan
		Biliary Colic
		Renal Colic
Vascular disorders	Ischemic	Mesenteric ischemia							Soft duffy fullness		Severe pain out of proportion to examination						CT Angiogram, MRI
	Ischemic	Acute ischemic colitis															CT scan, Colonoscopy
	Hemorrhagic	Ruptured abdominal aortic aneurysm
	Hemorrhagic	Intraabdominal or Retroperitoneal hemorrhage
Gynecologic Causes	Ovarian Cyst Complications	Torsion
	Ovarian Cyst Complications	Rupture
	Ruptured Ectopic Pregnancy

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.

Template:WH Template:WS

[WuChen2016-1] 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.

[1]

@@ Line 14: / Line 14: @@
 {| Class="wikitable" style="border: 2; background: none;"
-! colspan="2" rowspan="2" |Classification of acute abdomen
+! colspan="2" rowspan="3" |Classification of acute abdomen
 based on the etiology
-! rowspan="2" |Presentation
+! rowspan="3" |Presentation
-! rowspan="2" | '''Typical History'''
+! colspan="6" |Symptoms
-! rowspan="2" |Localization of the abdominal pain
+! colspan="7" rowspan="1" | '''Signs'''
-! rowspan="2" |Symptoms and signs
+! rowspan="3" | '''Lab findings'''
-! rowspan="2" |Specific signs
+! rowspan="3" |Preferred diagnostic test
-! colspan="9" rowspan="1" | '''Physical findings'''
+! rowspan="3" |Additional findings
-! rowspan="2" | '''Diagnostic tests''' and '''Lab findings'''
-! rowspan="2" |Choice of Imaging
-! rowspan="2" | '''Treatment'''
-! rowspan="2" |Other comments
 |-
-!Appearance of the patient/ shape of the abdomen
+! rowspan="2" |Fever
-!Abdominal tenderness
+! rowspan="2" |Jaundice
-!Shifting dullness
+! rowspan="2" |Nausea/
-!Rigidity and Guard ing
+Vomiting
-!Deep tenderness
+! rowspan="2" |Diarrhea
-!Rebound tenderness
+! rowspan="2" |Constipation
-!Cough tenderness
+! rowspan="2" |Abdominal
-!Bump tenderness
+Pain
-!Bowel sounds
+Location
+! rowspan="2" |General
+Appearance
+! rowspan="2" |Bowel Sounds
+! colspan="2" |Abdominal tenderness
+! rowspan="2" |Shifting dullness
+! rowspan="2" |Rigidity
+! rowspan="2" |Rebound tenderness
+|-
+!Superficial
+!Deep
 |-
 ! rowspan="9" |Common causes of peritonitis
 !Primary peritonitis
 !Spontaneous bacterial peritonitis
+!
+!
 !
 !
@@ Line 45: / Line 54: @@
 !
 !Motionless
+!
 !✔
+!
 !✔
-!✔
-!
 !✔
 !✔
 !
-!Absent (late)
 !
+!
+|-
+! rowspan="8" |Inflammatory disorders and perforations causing Secondary peritonitis
+!Perforated gastro-duodenal ulcers
 !
 !
 !
-|-
-!rowspan="8" |Inflammatory disorders and perforations causing Secondary peritonitis
-!Perforated gastro-duodenal ulcers
 !
 !
 !
-!Loss of liver dullness due to free air accumulating under the diaphragm
 !Scaphoid, tense abdomen
 !
-!
-!✔
 !
 !
 !
+!✔
 !
-!Diminished (late)
 !
 !CT scan
-!
 !
 |-
 !Acute cholangitis
 !
-!Right upper quadrant
+!
-!Jaundice,fever,confusion,shock
+!
 !
 !
@@ Line 94: / Line 99: @@
 !
 !Ultrasound, CT, ERCP, MRCP, PTC
-!Biliary decompression +
-Broad spectrum antibiotics
 !Charcot triad ( RUQ pain, jaundice,fever)
@@ Line 105: / Line 107: @@
 !
 !
-!Murphy sign
 !
-!✔
 !
 !
 !
+!
+!✔
 !
 !
@@ Line 117: / Line 119: @@
 !
 !Ultrasound
-!
 !
 |-
@@ Line 136: / Line 137: @@
 !Serum amylase/lipase
 !CT scan
-!
 !
 |-
@@ Line 145: / Line 145: @@
 !
 !
-!✔
 !
 !
 !
+!✔
 !
 !
@@ Line 155: / Line 155: @@
 !
 !CT scan, ultrasound
-!
 !
 |-
 !Small and large bowel perforations
-!
 !
 !
@@ Line 183: / Line 181: @@
 !
 !
-!✔
 !
 !
 !
+!✔
 !
 !
@@ Line 193: / Line 191: @@
 !
 !CT scan
-!
 !
 |-
 !Acute salpingitis
-!
 !
 !
@@ Line 215: / Line 211: @@
 !
 |-
-! colspan="2" rowspan="2" |Visceral Abscess
+! colspan="2" rowspan="3" |Hollow Viscous Obstruction
-!Splenic abscess
+!Intestinal obstruction
-!
-!
-!
 !
 !
@@ Line 226: / Line 219: @@
 !
 !
+!Dissension of the abdomen
 !
 !
@@ Line 233: / Line 227: @@
 !
 !
+!Flat and upright film, CT scan
 !
 |-
-!Hepatic abscess
+!Biliary Colic
-!
 !
 !
@@ Line 254: / Line 248: @@
 !
 |-
-! colspan="2" rowspan="3" |Obstruction
+!Renal Colic
-!Intestinal obstruction
 !
 !
 !
 !
-!Dissension of the abdomen
 !
 !
@@ Line 268: / Line 260: @@
 !
 !
-!Hyper peristalsis
-(early) Visible
-peristalsis / quiet abdomen (late)
 !
-!Flat and upright film, CT scan
 !
 !
-|-
-!Biliary Colic
 !
 !
+|-
+! rowspan="4" |Vascular disorders
+! rowspan="2" |Ischemic
+!Mesenteric ischemia
 !
 !
@@ Line 287: / Line 275: @@
 !
 !
+!Soft duffy fullness
 !
+!Severe pain out of proportion to examination
 !
 !
@@ Line 293: / Line 283: @@
 !
 !
+!CT Angiogram, MRI
 !
+|-
+!Acute ischemic colitis
 !
 !
-|-
-!Renal Colic
 !
 !
@@ Line 310: / Line 301: @@
 !
 !
+!CT scan,
+Colonoscopy
 !
+|-
+! rowspan="2" |Hemorrhagic
+!Ruptured abdominal aortic aneurysm
 !
 !
 !
 !
-|-
-! colspan="3" |Paralytic ileus
 !
 !
 !
 !
-!Distension/ soft doughy fullness
-!✘
 !
 !
@@ Line 329: / Line 322: @@
 !
 !
-!Minimally heard
 !
 !
+|-
+!Intraabdominal or Retroperitoneal hemorrhage
 !
 !
-|-
-! rowspan="4" |Vascular disorders
-! rowspan="2" |Ischemic
-!Mesenteric ischemia
 !
 !
 !
 !
-!Soft duffy fullness
-!Severe pain out of proportion to examination
 !
 !
@@ Line 352: / Line 340: @@
 !
 !
-!CT Angiogram, MRI
 !
 !
 |-
-!Acute ischemic colitis
+! rowspan="3" |Gynecologic Causes
+! rowspan="2" |Ovarian Cyst Complications
+!Torsion
 !
 !
@@ Line 371: / Line 360: @@
 !
 !
-!CT scan,
-Colonoscopy
 !
 !
 |-
-! rowspan="2" |Hemorrhagic
+!Rupture
-!Ruptured abdominal aortic aneurysm
-!
 !
 !
@@ Line 397: / Line 381: @@
 !
 |-
-!Intraabdominal or Retroperitoneal hemorrhage
+!Ruptured Ectopic Pregnancy
 !
 !

Spontaneous bacterial peritonitis differential diagnosis: Difference between revisions

Revision as of 17:46, 24 January 2017

Overview

Differentiating Spontaneous bacterial peritonitis from other Diseases

References

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