Editing Spontaneous bacterial peritonitis


SBP

== '''Risk factors''' ==

* Nearly always an indicator of severe liver disease - mostly CP-C. Poor short and long-term prognosis.
* 30% of cirrhotic patients with ascites develop it

== '''Pathophysiology''' ==

* An ascites fluid infection that occurs spontaneously without any overt source - probably mostly spreads from blood, or direct bacterial translocation through bowel. But the primary source is most likely GIT.
* Translocation may occur due to intestinal hypo-motility and increased permeability
* Can also occur with haematogenous spread from a non-GIT source
* Possible with only minimal ascites, although there is often large volume ascites

== '''Bacteriology''' ==

* Most commonly E coli and Klebsiella pneumoniae
* 90% gram-negative enteric organisms

== Presentation ==

* Can be asymptomatic initially
* Fever
* Abdominal pain
* Jaundice
* Confusion
* Peritonitis may be absent - as few as 10% have rebound tenderness at presentation

== Diagnosis ==

* Clinical signs and symptoms are not sufficient - need paracentesis
* Ascitic fluid with neutrophil count > 250 cells/mm(3)
* Difficult to differentiate from secondary peritonitis - send ascitic sample for total protein, LDH and glucose. 
* Features suggestive of secondary peritonitis:
** Multiple organisms on culture
** Very high ascitic neutrophil counts
** Ascitic fluid total protein >1g/dL
** Ascitic fluid LDH greater than half upper limit of serum
** Ascitic fluid glucose < 50mg/dL
* If above features found:
** CT - to look for perforation/abscess

== Treatment ==

* Empiric Abx once sample taken
* IV albumin 1.5g/kg within 6 hours of SBP diagnosis and 1g/kg on day 3 if BUN < 30mg/dL, serum creatinine >1mg/dL, or total bilirubin < 4mg/dL

== Prophylaxis ==

* Oral ciprofloxacin 750mg weekly

[[Category:Liver]]