<unk>  <unk>  is a form of peritonitis that occurs in most of the patients with advanced cirrhosis, in 10-30% of hospitalized patients with ascites and in various other clinical settings, such as nephrotic syndrome, heart failure, tuberculous infection, continuous ambulatory peritoneal dialysis for chronic renal failure. <unk>  is diagnosed with a positive<unk>  culture for a single organism and an AF ( ascitic fluid) : polymorphonuclear (PMN) cell count of > 250/mm3, in the absence of a surgically treatable intra-abdominal source of infection. More than 60% of<unk>  episodes are caused by enteric gram-negative organisms such as Escherichia coli and Kleibsella. Selective intestinal decontamination (SID) with fluorinated quinolones suppresses the gram-negative intestinal flora and is known to reduce the incidence of<unk> .<unk>  results due to the inability of the gut to contain<unk> and failure of the immune system to eradicate the organisms once they have escaped into the blood stream. Clinical signs and symptoms are non specific and indistinguishable from secondary peritonitis. Ascitic fluid analysis is helpful in differentiating<unk>  from secondary peritonitis. Because of the lack of specificity and sensitivity of clinical signs and symptoms, cirrhotic patients with unexplained deterioration should undergo a diagnostic paracentesis. Once diagnosed, patients with<unk>  should receive prompt empiric antibiotic treatment ( Cephalosporins) without waiting for the ascitic fluid culture. Failure of prompt initiation of antibiotics results in  significant and potentially fatal deterioration in the clinical status of the patient. Patients who survive an episode of<unk>  are at high risk of recurrence. Patients with cirrhosis and ascites developing abdominal pain and/or temperature >100F are more prone to have<unk>  and should receive empiric antibiotic treatment. Early detection and treatment improve outcome and prevent complications such as shock and renal failure.
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Spontaneous bacterial peritonitis
Secondary peritonitis
Gallstone ileus
Ascending cholangitis
Acute cholecystitis
Splenic abscess
Superior mesenteric artery syndrome
Bowel obstruction