Bacterial Peritonitis: Causes and Treatments

Bacterial peritonitis represents a significant medical condition that can arise due to various underlying factors. It is imperative for healthcare professionals, patients, and caregivers to possess a comprehensive understanding of its causes, symptoms, diagnostic methods, and treatment options.

What is Bacterial Peritonitis?

Bacterial peritonitis is an inflammation of the peritoneum, the thin tissue lining the inner wall of the abdomen and covering most of the abdominal organs. This condition occurs when bacteria invade the peritoneal cavity, leading to infection. It can be either primary, known as spontaneous bacterial peritonitis (SBP), or secondary, stemming from a different source such as a perforated organ.

Spontaneous Bacterial Peritonitis (SBP)

Spontaneous bacterial peritonitis is a common complication in patients with liver cirrhosis and ascites. It occurs without an apparent source of infection and is caused by the translocation of bacteria from the intestines into the peritoneal cavity. The ICD-10 code for spontaneous bacterial peritonitis is K65.2, which is essential for proper medical documentation and billing.

Causes of Bacterial Peritonitis

The causes of bacterial peritonitis can be classified based on whether the condition is primary or secondary. Understanding these causes is critical for effective diagnosis and treatment.

Causes of Spontaneous Bacterial Peritonitis

Spontaneous bacterial peritonitis primarily affects individuals with liver cirrhosis and ascites. The underlying mechanisms include:

Bacterial Translocation: This involves the migration of bacteria from the intestinal lumen to mesenteric lymph nodes and subsequently to the systemic circulation, finally reaching the peritoneal cavity.
Impaired Immune Response: Patients with liver cirrhosis often exhibit compromised immune function, making them more susceptible to infections.
Altered Intestinal Permeability: Cirrhosis can lead to changes in the intestinal barrier, facilitating bacterial translocation.

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Causes of Secondary Bacterial Peritonitis

Secondary bacterial peritonitis arises from an identifiable source within the abdomen, such as:

Perforated Peptic Ulcer: The release of gastric contents into the peritoneal cavity can lead to infection.
Ruptured Appendix or Diverticulum: These conditions result in the leakage of intestinal bacteria into the peritoneal space.
Bowel Obstruction or Ischemia: Necrotic bowel tissue can become a source of infection.

Symptoms of Bacterial Peritonitis

The symptoms of bacterial peritonitis can vary depending on the severity of the infection and the individual's overall health. Common symptoms include:

Abdominal Pain and Tenderness: Patients often experience diffuse abdominal pain that may be accompanied by tenderness.
Fever and Chills: A systemic response to infection, characterized by elevated body temperature and chills.
Nausea and Vomiting: Gastrointestinal symptoms are prevalent due to the inflammatory process.
Altered Mental Status: Particularly in cases of SBP, patients may exhibit confusion or altered consciousness.

Diagnosis of Bacterial Peritonitis

Accurate diagnosis is crucial for the effective management of bacterial peritonitis. Several diagnostic tools and procedures are utilized to confirm the presence of the infection.

Paracentesis

Paracentesis is a critical procedure for diagnosing SBP. It involves the extraction of ascitic fluid from the peritoneal cavity for analysis. Key diagnostic parameters include:

Polymorphonuclear Leukocyte (PMN) Count: A PMN count of ≥250 cells/mm³ in ascitic fluid is indicative of SBP.
Bacterial Culture: Culturing the ascitic fluid helps identify the causative organism.

Imaging Studies

Imaging techniques such as ultrasound and CT scans can aid in identifying potential sources of infection in cases of secondary bacterial peritonitis. These studies help visualize abscesses, perforations, or other abdominal abnormalities.

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Treatment of Bacterial Peritonitis

Effective treatment of bacterial peritonitis involves a combination of antimicrobial therapy, supportive care, and, in some cases, surgical intervention. The approach varies based on whether the condition is primary or secondary.

Treatment of Spontaneous Bacterial Peritonitis

Antibiotic Therapy: Empirical antibiotic treatment is initiated promptly upon diagnosis. Commonly used antibiotics include third-generation cephalosporins such as cefotaxime.
Albumin Infusion: Intravenous albumin is administered to prevent renal impairment, a common complication in SBP.
Long-term Prophylaxis: Patients with a history of SBP may require long-term antibiotic prophylaxis to prevent recurrence.

Treatment of Secondary Bacterial Peritonitis

Surgical Intervention: In cases where a source of infection is identified, such as a perforated organ, surgical repair is necessary.
Broad-Spectrum Antibiotics: Initial treatment involves broad-spectrum antibiotics to cover a wide range of potential pathogens.
Drainage of Abscesses: If abscesses are present, percutaneous or surgical drainage may be required.

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