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Renal Disease; Fluid and Electrolyte Disorders
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The main complication is infection, either of skin and tissues around the tube or of the peritoneal cavity, causing peritonitis. This type of peritonitis is treated with antibiotics and repeated washing out of the peritoneum.
Gynaecology, Fertility and Family Planning
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Zahra Ameen, Kopal Singhal Agarwal, Chawan Baran, Lauren Laws, Maria Garcia de Frutos, Black Benjamin
Upper genital tract infections are possible in all women with lower abdominal pain. Other causes include endometritis and salpingitis. Potential complications include pelvic abscess, septicaemia and peritonitis.
Treatment of Abdominal Sepsis
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
While significant organ dysfunction or septic shock is present in the minority of cases of peritonitis (5% of patients with peritonitis), those with organ dysfunction and/or septic shock are at significantly greater risk of both failure of source control and mortality (relative risk—19) [1, 4]. For this summary, failure of source control is defined as persistent or recurrent intraabdominal infection and/or anastomotic failure in the setting of technically appropriate source control procedures. Failure of source control in this setting represents an altered ability to clear pathogens and heal anastomoses. Several patient factors present on ICU admission are independently associated with subsequent failure of source control following treatment of peritonitis, most of which reflect severity of illness, including high APACHE score, low serum albumin, need for vasoactive/inotropic support, degree of peritoneal inflammation/contamination, and age. An analysis of a randomized trial of antibiotic therapy treating peritonitis demonstrated that an APACHE II score of ≥15 was associated with a 50% rate of failed source control [5]. While no prediction tools for failure of source control have been validated for clinical practice, recognizing that patients requiring vasoactive support and with significant organ dysfunction in the perioperative period may have source control failure rates exceeding 50% is critical for appropriate management.
CD64 expression on neutrophils as a potential biomarker for bacterial infection in ascitic fluid of cirrhotic patients
Published in Infectious Diseases, 2023
Elena González-López, Aitor Odriozola Herrán, Mónica Renuncio García, Adriel Roa-Bautista, Ángela Antón Rodríguez, Alejandra Comins-Boo, Juan Irure Ventura, Ángela Puente, Marcos López-Hoyos, José Igancio Fortea, David San Segundo
The microbiologic culture of ascitic fluid is an important tool in diagnosing bacterial infections. Some cirrhotic patients develop bacterascites, defined by a positive culture and PMN count < 250 cells/mm3 in the absence of an evident intra‐abdominal, surgically treatable source of infection [2]. Moreover, a small proportion of patients could develop secondary bacterial peritonitis due to perforation or inflammation of the intra-abdominal organ. In this case, the diagnosis is suspected in those with localised abdominal symptoms or signs, very high ascitic neutrophil count, multiple organisms on ascitic culture, or those with inadequate response to treatment [2]. Regarding microbiological culture for the diagnosis of bacterial infections, it may take several days until results are obtained, and it could be influenced by handling processes, transport, and treatment, increasing the false negative results [3].
Advances in the pharmacological management of bacterial peritonitis
Published in Expert Opinion on Pharmacotherapy, 2021
Daniel Pörner, Sibylle Von Vietinghoff, Jacob Nattermann, Christian P Strassburg, Philipp Lutz
Pharmacological management of bacterial peritonitis is focused on antibiotic treatment. Microbiological sampling prior to empiric therapy is essential for the deliberate use of antibiotics. Given the rising prevalence of MDR, adaption of the antibiotic therapy to the patient’s risk for MDR is necessary in order to reduce the rate of treatment failure, especially in patients with severe peritonitis. Secondary peritonitis demands evaluation of surgery for adequate source control. The underlying medical condition has major implications on the expected microbial spectrum and the prognosis of the patient: in patients with cirrhosis, gram-negative bacteria and enterococci dominate and mortality is high due to the dysregulated immune response these patients tend to develop. Patients with liver cirrhosis should receive secondary antibiotic prophylaxis after SBP. In patients on PD, bacterial peritonitis is usually caused by gram-positive bacteria and may necessitate a change of dialysis modality to hemodialysis, which has a major impact on the quality of life of these patients.
Methotrexate induced peritonitis: diagnosis per exclusionem
Published in Journal of Obstetrics and Gynaecology, 2021
Raphaël Rienstra, Eva A.S. Koster, Catharina C.A.H. Janssen
Gastritis (Helicobacter pylori).Gastric ulcer.Stomach perforation.Cholecystitis.Pancreatitis.Pulmonary embolism.Peritonitis.Pericarditis.Molar metastasis.Coeliac disease.