see: [Hayes' spontaneous bacterial peritonitis](x-devonthink-item://5B46244E-99B0-47A3-BE33-14418563B631), [Dunn Spontaneous bacterial peritonitis](x-devonthink-item://4E714AD5-C8F4-45FC-9BB3-8CAFA2E8ADD2) see also: [[Peritoneal dialysis]] **Causes** - e coli - enterococci - staph (aureus or other) - klebsiella - psedomonas - anaerobes **Features** - ascites - fever not always present - abdo pain in 95% ; not usually peritonitic though - nausea, vomiting, diarrhoea - confusion / hepatic encephalopathy # investigations ## ascites tap (Not to be confused with [[Pleural effusion#Light's criteria]]) - cloudy macroscopic appearance - neutropils: subtract 1 neutrophil for every 250 RBCs in blood-stained taps **Diagnosis** - WCC > 250 (often > 1000) (note >100 for peritoneal dialysis-related peritonitis) - ascitic/serum LDH ratio ≥ 0.5 - glucose < 2.8 - protein > 10 - +ve leucocyte esterase - + gram stain - pH < 7.35 **DDx** - perforated viscus - appendicitis - pancreatitis # management - ceftriaxone # SBP from peritoneal dialysis see: [[Peritoneal dialysis#Peritonitis from peritoneal dialysis]]