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===Spontaneous versus secondary bacterial peritonitis===
*Importance of distinction
**Mortality of secondary bacterial peritonitis (eg. perforated [[appendicitis]], [[cholecystitis]]) ~100% if treatment is only antibiotics without surgery
**Mortality of unnecessary surgery in patients with SBP ~80%
*Laboratory findings
**Secondary bacterial peritonitis strongly suggested by:
***Neutrocytic fluid (PMN ≥250) with two or more of the following:
****Total protein concentration >1 g/dL (10 g/L)
****Glucose concentration <50 mg/dL (2.8 mmol/L) 
****LDH greater than upper limit of normal for serum
***Ascitic alk phos >240  
***[[Gram stain]]
****Large numbers of different bacterial forms 
*Imaging
**If evidence of secondary bacterial peritonitis obtain abdominal imaging
***If no evidence of free air or contrast extravasation then surgery is not indicated