Term
| What organ or organ parts are contained in the retroperitoneal space? |
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Definition
| duodenum, pancreas, kidneys, and adrenal glands |
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Term
| What organ or organ parts are located in the peritoneal cavity? |
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Definition
| appendix, ileum/jejunum, large bowel, liver, gall bladder, spleen, uterus, fallopian tubes, and ovaries |
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Term
| What are the 3 general ways that a host may respond to pathogen breach of the peritoneum? |
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Definition
| clear bacteria, form abscess, peritonitis |
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Term
| What is the mortality range for peritonitis (all 4 classifications)? |
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Definition
|
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Term
| What is another name for spontaneous bacterial peritonitis (SBP)? |
|
Definition
|
|
Term
| What is another name for primary peritonitis? |
|
Definition
| spontaneous bacterial peritonitis (SBP) |
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Term
| What are the general classifications of intra - abdominal infections? |
|
Definition
| primary peritonitis, secondary peritonitis, tertiary peritonitis, peritonitis complicating peritoneal dialysis (PD) |
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Term
| Most cases of ascites occur due what? |
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Definition
|
|
Term
| What are some causes of ascites other than alcoholic cirrhosis? |
|
Definition
| SCANNC - SLE, CHF, Acute viral hepatitis, Necrotic cirrhosis, Nephrotic syndrome, Chronic active hepatitis |
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|
Term
| What is the leading theory of how primary peritonitis develops? |
|
Definition
|
|
Term
| What is the mortality rate of SBP today? |
|
Definition
|
|
Term
| Primary peritonitis develops in what percentage of patients with cirrhosis? |
|
Definition
|
|
Term
| Aside from ascites what are the predisposing factors for developing primary peritonitis? |
|
Definition
| CHUBBI P's - CHild - Pugh class C, UTI, T Bili > 2.5 mg / dL, gi Bleeding, Intravascular catheters, Previous SBP, ascitic fluid total Proein < 1 g / dL |
|
|
Term
| What symptoms develop as SBP progresses? |
|
Definition
| FALDA - Fever (~ 70%), Abdominal pain / tenderness (50 - 60%), Leukocytosis, Diarrhea, Altered mental status (50 - 60%) |
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|
Term
| What is the gold standard for SBP diagnosis? |
|
Definition
|
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Term
| What tests are done on ascitic fluid obtained during paracentesis? |
|
Definition
| Gram stain, culture, WBCs |
|
|
Term
| What is the PMN diagnostic cutoff to start antibiotics if not already started for SBP? |
|
Definition
|
|
Term
| How is PMN count corrected if traumatic tap occurs during paracentesis? |
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Definition
| subtract "1" PMN for every "250" RBCs in ascitic fluid |
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|
Term
| What are the typical causative organisms of SBP? |
|
Definition
| 60 - 70% Gram neg. enteric bacteria (E.coli, Klebsiella pneumo.), ~ 25% Gram pos. cocci (usually Streptococcus, 2 - 4% Staph. aureus), very rarely anaerobes / polymicrobial |
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Term
| What are the standard empiric therapies for SBP? |
|
Definition
| Cefotaxime 2g IV Q8H, ceftriaxone 2g IV Q24H |
|
|
Term
| What are the SBP choices for empiric therapy when resistant / ESBL producing organism is suspected? |
|
Definition
| 1st choice is Carbapenems (imipenem, meropenem, doripenem), FQs (cipro-, levo-, moxi-, likely cross-resistant if ESBL), penicillin allergic (aztreonam, likely cross-resistant if ESBL producing) |
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|
Term
| What route of administration is almost always required for SBP? Why? |
|
Definition
| Parenteral - patients usually critically ill; often with GI bleed or ileus, need to cover Strep. and gram negatives, need high concentrations in ascitic fluid |
|
|
Term
| What is the duration of therapy for SBP? |
|
Definition
| 5 days, 14 days if blood cultures are positive |
|
|
Term
| What specific groups of cirrhotic patients are shown to benefit from SBP prophylaxis? |
|
Definition
| GI bleed, previous SBP, ascitic fluid albumin < 1g / dL |
|
|
Term
| What are the SBP prophylaxis regimens? |
|
Definition
| GI bleed norfloxacin 400 mg PO Q12H X7 days, previous SBP (until resolution of ascites / transplant) & AF albumin < 1g / dL (during hospitalization) - cipro 750 mg PO QW; Bactrim DS PO QD X5 days / week; norfloxacin 400 mg PO QD |
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