Snapshot A 46-year-old man with chronic alcohol abuse and advanced cirrhosis presents with worsening abdominal pain and confusion. On evaluation in the emergency room, his temperature is 101.4°F (38.6°C), blood pressure is 125/80 mmHg, pulse is 106/min, and respirations are 22/min. On physical exam, there is abdominal distension with a fluid wave and diffuse abdominal tenderness to palpation with rebound tenderness. Introduction Clinical definition login to view 1 more bullet Associated conditions login to view 5 more bullets Epidemiology Occurs in up to 20% of patients with ascites High recurrence rate Most commonly from a single organism login to view 3 more bullets ETIOLOGY Pathogenesis login to view 4 more bullets Presentation Symptoms login to view 5 more bullets Physical exam login to view 4 more bullets Studies Diagnostic testing login to view 15 more bullets Differential Secondary peritonitis login to view 4 more bullets Nephrolithiasis login to view 2 more bullets Treatment Management approach login to view 4 more bullets First-line antibiotic login to view 3 more bullets Complications Renal failure Sepsis and septic shock Death