Spontaneous bacterial peritonitis differential diagnosis: Difference between revisions

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* [[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]].
* [[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. <ref name="WuChen2016">{{cite journal|last1=Wu|first1=Hongli|last2=Chen|first2=Lin|last3=Sun|first3=Yuefeng|last4=Meng|first4=Chao|last5=Hou|first5=Wei|title=The role of serum procalcitonin and C-reactive protein levelsin predicting spontaneous bacterial peritonitis in patients with advanced liver cirrhosis|journal=Pakistan Journal of Medical Sciences|volume=32|issue=6|year=2016|issn=1681-715X|doi=10.12669/pjms.326.10995}}</ref>
* 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. <ref name="WuChen2016">{{cite journal|last1=Wu|first1=Hongli|last2=Chen|first2=Lin|last3=Sun|first3=Yuefeng|last4=Meng|first4=Chao|last5=Hou|first5=Wei|title=The role of serum procalcitonin and C-reactive protein levelsin predicting spontaneous bacterial peritonitis in patients with advanced liver cirrhosis|journal=Pakistan Journal of Medical Sciences|volume=32|issue=6|year=2016|issn=1681-715X|doi=10.12669/pjms.326.10995}}</ref>
{| Class="wikitable" style="border: 2; background: none;"                                                       
! colspan="2" rowspan="3" |Classification of acute abdomen
based on the etiology
! rowspan="3" |Presentation
! colspan="6" |Symptoms
! colspan="7" rowspan="1" | '''Signs'''
! rowspan="3" | '''Lab findings'''
! rowspan="3" |Preferred diagnostic test
! rowspan="3" |Additional findings
|-
! rowspan="2" |Fever
! rowspan="2" |Jaundice
! rowspan="2" |Nausea/
Vomiting
! rowspan="2" |Diarrhea
! rowspan="2" |Constipation
! rowspan="2" |Abdominal
Pain
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="8" |Common causes of peritonitis
!Primary peritonitis
!Spontaneous bacterial peritonitis
!✔
!✘
!✔/✘
!✘
!✘
!diffuse
!lies supine motionless
tense abdomen due to ascites
!diminished
!✔
!✘
!✔
!✘
!✘
!Ascitic fluid PMN>250cells/mm3
Single organism on culture of the ascitic fluid
!ascitic fluid PMN count
!Altered mental status usually seen.
|-
! rowspan="7" |Inflammatory disorders and perforations causing Secondary peritonitis
!Perforated gastro-duodenal ulcers
!✔
!✘
!✔/✘
!✘
!✘
!right upper quadrant
!Scaphoid, tense abdomen
!✘
!✔
!✘
!✘
!✔
!✔
!Fulfillment of 2/3 runyon's criteria:
glucose < 50mg/dl
total protein > 1g/dl
LDH ascites > normal LDH serum
!upright chest x-ray, CT scan
!
|-
!Acute cholangitis
!✔
!✔
!✘
!✘
!✘
!Right upper quadrant
!Toxic look
!normal
!✘
!✘
!✘
!✘
!✘
!
!Ultrasound, CT, ERCP, MRCP, PTC
!Charcot triad ( RUQ pain, jaundice,fever)
Reynold pentad ( RUQ pain, jaundice,fever, confusion,shock)
|-
!Acute cholecystitis
!✔
!
!✔
!✘
!✘
!Right upper quadrant or epigastrium may radiate to the right shoulder or back
!
!
!✔ right upper abdomen
!✘
!✘
!✘
!✘
!
!Ultrasound
!Murphy's sign (pain on inspiration causing a cessation of breathing) may be present
|-
!Acute pancreatitis
!✔
!
!✔
!
!
!midepigastrium, right upper quadrant, diffuse, or, infrequently, confined to the left side with a band-like radiation to the back
!
!
!✔epigastrium
!✘
!✘
!✘
!✘
!Serum amylase/lipase
!CT scan
!
|-
!Acute appendicitis
!✔
!
!
!✘
!✘
!vague periumbilical initially that eventually localises to right lower quadrant
!
!
!✔right lower quadrant
!
!
!
!
!
!CT scan, ultrasound
!
|-
!Acute diverticulitis
!✔
!✘
!✔
!✔/✘
!✔/✘
!Left lower quadrant pain
!
!
!✔left lower quadrant
!
!
!
!
!
!CT scan
!leukocytosis
|-
!Acute salpingitis
!✔
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
|-
! colspan="2" rowspan="4" |Hollow Viscous Obstruction
!small Intestinal obstruction
!
!
!✔
!
!
!periumbilical and crampy, with paroxysms of pain occurring every 4-5minutes.Pain progresses from crampy to constant and more severe indicating impending strangulation
!Dissension of the abdomen
!
!
!
!
!
!
!
!Flat and upright film, CT scan
!
|-
!Volvulus
!
!
!✔
!
!✔ in sigmoid volvulus
!steady pain, with a superimposed colicky component
!
!
!
!
!
!
!
!
!
!
|-
!Biliary Colic
!
!
!✔
!
!
!right upper quadrant
!
!
!
!
!
!
!
!
!CT scan
!hepatomegaly and a palpable gallbladder(courvoisier sign) pancreatic head tumor
|-
!Renal Colic
!
!
!
!
!
!colicky and radiates to the flank or groin
!
!
!
!
!
!
!
!
!
!Hematuria
|-
! rowspan="4" |Vascular disorders
! rowspan="2" |Ischemic
!Mesenteric ischemia
!
!
!✔
!
!
!severe periumbilical pain out of proportion to physical examination findings
!Soft duffy fullness
!
!Severe pain out of proportion to examination
!
!
!
!
!increased lactic acid and leukocytosis
!Abdominal x-ray, CT Angiogram, MRI
!
|-
!Acute ischemic colitis
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!CT scan,
Colonoscopy
!
|-
! rowspan="2" |Hemorrhagic
!Ruptured abdominal aortic aneurysm
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!cullen sign(bruising around the umbilicus)
|-
!Intraabdominal or Retroperitoneal hemorrhage
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!Grey turner sign(bruising in the flank)
|-
! rowspan="3" |Gynecologic Causes
! rowspan="2" |Ovarian Cyst Complications
!Torsion
!
!
!✔
!
!
!lower abdominal pain
!
!
!
!
!
!
!
!
!
!
|-
!Rupture
!
!
!
!
!
!focal,unilateral lower abdominal pain accompanied by light vaginal bleeding
!
!
!
!
!
!
!
!measurement of human chorionic gonadotropin and alpha-fetoprotein
!transvaginal ultrasonography
!
|-
! colspan="2" |Ruptured Ectopic Pregnancy
!✘
!✘
!✔/✘
!✘
!✘
!lower abdominal quadrant and pelvis
!toxic look
!normal
!✘
!✘
!✘
!✘
!✘
!urine b-hcg +,
!transvaginal ultrasonography and serial testing of hCG
!Amenorrhea and vaginal bleeding.
|}


==References==
==References==

Revision as of 03:42, 31 January 2017

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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]

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:

References

  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.


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