Rimola et al listed criteria for when to suspect secondary peritonitis in a patient with cirrhosis and ascites. The authors are from multiple universities in the Europe and the United States.
When to suspect secondary peritonitis - one or more of the following:
(1) failure to respond to adequate therapy for spontaneous bacterial peritonitis
(2) isolation of 2 or more organisms on culture of the peritoneal fluid
(2a) isolation of anaerobic bacteria, yeast or fungi increases the likelihood
(3) 2 or more of the following:
(3a) LDH of the peritoneal fluid > serum LDH
(3b) protein of the peritoneal fluid > 1 g/dL (> 10 g/L)
(3c) glucose of the peritoneal fluid < 50 mg/dL
where:
• Another finding suggesting secondary peritonitis is the presence of food debris in a smear of the fluid.
If there is a significant possibility of secondary peritonitis then the patient should undergo imaging studies to try to locate the source.
To read more or access our algorithms and calculators, please log in or register.
