Spontaneous Bacterial Peritonitis The peritoneum is the name given for the inside of the abdomen where the stomach, intestines and colon reside.  Peritonitis is a disease state in which the peritoneum becomes infected.  "Spontaneous" means that the infection occurred without a specific cause.  Secondary Bacterial Peritonitis is an infection that occurs due to specific causes, such as when the bowel is perforated and feces gets into the peritoneum. Feeling ill Fever Abdominal pain Confusion Mental changes Examination: Ascites (fluid) present -- abdomen is enlarged from fluid Liver may be enlarged Abdominal tenderness (only in about 50%) Tenderness to percussion (only in about 15%) Laboratory: Paracentesis is performed -- fluid is taken from abdomen and sent to the laboratory to check for cell count and culture. If the total protein in the peritoneal fluid is greater than 1gram/dL, it is unlikely that spontaneous peritonitis is the diagnosis. If the cell count is greater than 250 neutrophils/uL, then the diagnosis is most likely bacterial peritonitis. If cell count is greater than 10,000 neutrophils/uL, glucose level is low(<50mg/dL), LDH is greater than serum LDH, or total protein is above 1 gram, all suggest secondary bacterial peritonitis. Occurs almost exclusively in persons with Ascites (fluid in the abdomen) due to liver disease Third generation Cephalosporin antibiotic such as Cefotaxime Ampicillin is added if the Enterococcus infection is suspected You need immediate emergency medical treatment.  If treated early, there is an over 90% cure rate, but if it is not caught early, there is risk of death of approximately 50%. In those persons who have had repeat episodes of Spontaneous Bacterial Peritonitis, prophylaxis (continued treatment) with daily antibiotics such as Trimethoprim-sulfamethoxazole or Norfloxacin. If persons who have not had Spontaneous Bacterial Peritonitis, but are at high risk (low-protein <1gram/dL in peritoneal fluid), are usually treated with prophylactic Trimethoprim-Sulfamethoxazole (5 days per week) or ciprofloxacin once a week Secondary bacterial peritonitis Tuberculous peritonitis Peritoneal carcinomatosis