Secondary and Spontaneous Bacterial Peritonitis in Patients With Liver Cirrhosis and Ascites

in class B. Peritonitis in Child-Pugh class A cirrhosis is probably secondary. IAC (International Ascites Club) recommends the SBP diagnosis to be taken in polymorphonuclear leucocytes (PMNs) in ascitic fluid >250/mm3 regardless of the result of bacterial cultures. Leucocytes /and ascitic fluid total protein (AFTP)/ increase in ascitic fluid after diuretic treatment, but not the PMNs. In patients with AFTP<10g/L the risk of SBP increases tenfold /decreased opsonic activity of ascitic fluid/. The ascitic bacterial cultures in SBP are rarely positive. At present, half of the episodes of SBP are caused by gram-positive bacteria. Blood cultures should be performed in all patients with suspected SBP. Bacterioscites (5%) does not need treatment, but monitoring, if there are no clinical symptoms and signs of systemic inflammation or infection. SecBP should be suspected in patients who have localized abdominal symptoms or signs, presence of multiple microorganisms (aerobes and anaerobes) in ascitic culture, very high ascitic neutrophil count and high ascitic total protein concentration. A SecBP should be suspected when at least two of the following features are present in ascitic fluid: glucose levels <50mg/dL, protein concentration >10g/L, lactic dehydrogenase concentration > normal serum levels. Due to the low sensitivity and specificity of these criteria for SecBP, examination of alkaline phosphatase (>225U/L) and carcinoembryonic antigen (>5ng/ml) in ascites are recommended /Runyon’s criteria/. Patients with suspected SecBP should undergo CT. Conclusion: The medical and surgical treatment of peritonitis in liver cirrhosis may be almost equally dangerous in wrong diagnosis.