Peritonitis laboratory findings

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Peritonitis Main Page

Patient Information

Overview

Causes

Classification

Spontaneous Bacterial Peritonitis
Secondary Peritonitis

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]

Overview

A diagnosis of peritonitis is based primarily on clinical grounds, that is on the clinical manifestations described above; if they support a strong suspicion of peritonitis, no further investigation should delay surgery. Leukocytosis and acidosis may be present, but they are not specific findings. Plain abdominal X-rays may reveal dilated, oedematous intestines, although it is mainly useful to look for pneumoperitoneum (free air in the peritoneal cavity), which may also be visible on chest X-rays. If reasonable doubt still persists, an exploratory peritoneal lavage may be performed (e.g. in cause of trauma, in order to look for white blood cells, red blood cells, or bacteria).

Laboratory Findings

SBP

  • Diagnostic paracentesis: is recommended to perform in all cirrhotic patients with ascites at the time of admission and/or in case of gastrointestinal (GI) bleeding, shock, signs of inflammation, hepatic encephalopathy, worsening of liver or renal function.
  • Ascitic fluid analysis and culture: performed before initiating antibiotic therapy by bedside inoculation of ascites ≥ 10 mL into blood culture bottles.
  • Recently leukocyte esterase calibrated reagent strips (LERS) to assess the PMN cell count (cut-off of > 250 PMN/mm3) are promised to provide good screening results when the strip turns any hue of tan/brown at 3 min.[1]

References

  1. Mendler MH, Agarwal A, Trimzi M, Madrigal E, Tsushima M, Joo E; et al. (2010). "A new highly sensitive point of care screen for spontaneous bacterial peritonitis using the leukocyte esterase method". J Hepatol. 53 (3): 477–83. doi:10.1016/j.jhep.2010.04.011. PMID 20646775.

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