TAILIEUCHUNG - Chapter 121. Intraabdominal Infections and Abscesses (Part 2 )

Primary (Spontaneous) Bacterial Peritonitis Peritonitis is either primary (without an apparent source of contamination) or secondary. The types of organisms found and the clinical presentations of these two processes are different. In adults, primary bacterial peritonitis (PBP) occurs most commonly in conjunction with cirrhosis of the liver (frequently the result of alcoholism). However, the disease has been reported in adults with metastatic malignant disease, postnecrotic cirrhosis, chronic active hepatitis, acute viral hepatitis, congestive heart failure, systemic lupus erythematosus, and lymphedema as well as in patients with no underlying disease. . | Chapter 121. Intraabdominal Infections and Abscesses Part 2 Primary Spontaneous Bacterial Peritonitis Peritonitis is either primary without an apparent source of contamination or secondary. The types of organisms found and the clinical presentations of these two processes are different. In adults primary bacterial peritonitis PBP occurs most commonly in conjunction with cirrhosis of the liver frequently the result of alcoholism . However the disease has been reported in adults with metastatic malignant disease postnecrotic cirrhosis chronic active hepatitis acute viral hepatitis congestive heart failure systemic lupus erythematosus and lymphedema as well as in patients with no underlying disease. Although PBP virtually always develops in patients with preexisting ascites it is in general an uncommon event occurring in 10 of cirrhotic patients. The cause of PBP has not been established definitively but is believed to involve hematogenous spread of organisms in a patient in whom a diseased liver and altered portal circulation result in a defect in the usual filtration function. Organisms multiply in ascites a good medium for growth. The proteins of the complement cascade have been found in peritoneal fluid with lower levels in cirrhotic patients than in patients with ascites of other etiologies. The opsonic and phagocytic properties of PMNs are diminished in patients with advanced liver disease. The presentation of PBP differs from that of secondary peritonitis. The most common manifestation is fever which is reported in up to 80 of patients. Ascites is found but virtually always predates infection. Abdominal pain an acute onset of symptoms and peritoneal irritation during physical examination can be helpful diagnostically but the absence of any of these findings does not exclude this often-subtle diagnosis. Nonlocalizing symptoms such as malaise fatigue or encephalopathy without another clear etiology should also prompt consideration of PBP in a susceptible patient.

• Y học thường thức
• Intraabdominal Infections and Abscesses
• bệnh học và điều trị
• bài giảng bệnh học
• tài liệu học ngành y
• Harrisons Internal Medicine
• medical books
• pharmacology
• epidemiologic
• Obstetrics
• anatomy
• Preventing Morbidity
• Multidisciplinary Care