Spontaneous bacterial peritonitis: Difference between revisions
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= Definition = |
== Definition == |
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* Primary infection of the ascitic fluid |
* Primary infection of the ascitic fluid, diagnosed by ascites fluid with positive culture or with neutrophil count greater than 250 |
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= Pathophysiology = |
== Pathophysiology == |
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* Intestinal bacterial overgrowth with increased intestinal permeability leads to translocation to intestinal lymph notes and bloodstream, which results in hematogenous seeding to ascitic fluid |
* Intestinal bacterial overgrowth with increased intestinal permeability leads to translocation to intestinal lymph notes and bloodstream, which results in hematogenous seeding to ascitic fluid |
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* Only occurs in portal hypertension, not in other causes of ascites |
* Only occurs in portal hypertension, not in other causes of ascites |
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= Bacteriology = |
== Bacteriology == |
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* ''Escherichia coli'' (43%) |
* ''Escherichia coli'' (43%) |
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** ''Aeromonas hydrophila'', in Korean |
** ''Aeromonas hydrophila'', in Korean |
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= Risk Factors = |
== Risk Factors == |
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* Previous history of SBP |
* Previous history of SBP |
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* Child-Pugh class |
* Child-Pugh class |
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= Presentation = |
== Presentation == |
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* Asymptomatic in 10% |
* Asymptomatic in 10% |
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* Hypothermia (15%) |
* Hypothermia (15%) |
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= Investigations = |
== Investigations == |
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* Labs |
* Labs |
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* Other |
* Other |
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= Management = |
== Management == |
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* Acute |
* Acute |
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* Some role for primary prophylaxis, I think? |
* Some role for primary prophylaxis, I think? |
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= Prognosis = |
== Prognosis == |
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* In-hospital mortality of about 33% in hospital |
* In-hospital mortality of about 33% in hospital |
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Revision as of 15:27, 17 August 2019
Definition
- Primary infection of the ascitic fluid, diagnosed by ascites fluid with positive culture or with neutrophil count greater than 250
Pathophysiology
- Intestinal bacterial overgrowth with increased intestinal permeability leads to translocation to intestinal lymph notes and bloodstream, which results in hematogenous seeding to ascitic fluid
- Only occurs in portal hypertension, not in other causes of ascites
Bacteriology
- Escherichia coli (43%)
- Klebsiella pneumoniae (11%)
- Streptococcus pneumoniae (9%)
- Other streptococcal species (19%)
- Enterobacteriaceae (4%)
- Staphylococcus (3%)
- Pseudomonas (1%)
- Miscellaneous (10%)
- Aeromonas hydrophila, in Korean
Risk Factors
- Previous history of SBP
- Upper GI bleed
- Low sciatic protein
- Child-Pugh class
Presentation
- Asymptomatic in 10%
- Fever (70%)
- Abdominal pain (60%)
- Hepatic encephalopathy (50%)
- Abdominal tenderness, usually without rigidity (50%)
- Diarrhea (30%)
- Ileus (30%)
- Shock (20%)
- Hypothermia (15%)
Investigations
- Labs
- Ascitic fluid for cell count and culture
- Neutrophil count < 250 rules it out
- Culture usually monomicrobial
- Repeat paracentesis at 48h if ongoing concern
- Ascitic fluid for cell count and culture
- Imaging
- Other
Management
- Acute
- Ceftriaxone 1-2g IV q24h
- Chronic
- Prophylaxis after a single episode
- Septra SS PO daily
- Norfloxacin
- Prophylaxis after a single episode
- Some role for primary prophylaxis, I think?
Prognosis
- In-hospital mortality of about 33% in hospital
- 58% 6-month mortality
References
- ^ Ngoc Nguyen, Matthew Crotty, Edward A. Dominguez, Adil Habib, Hector E. Nazario, Zahid M. Vahora, Parvez S. Mantry, Jessiva Rago, Melanie Proffitt, Maisha N. Barnes, Ashwini Mehta, Mangesh R. Pagadala, Jeffrey S. Weinstein. Doxycycline for the prevention of spontaneous bacterial peritonitis. The Liver Meeting. 2023.
