Spontaneous bacterial peritonitis: Difference between revisions
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| − | = Definition = |
+ | == Definition == |
| − | * 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 |
| − | = Pathophysiology = |
+ | == 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 |
* 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 == |
* ''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 == |
* Previous history of SBP |
* Previous history of SBP |
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* Child-Pugh class |
* Child-Pugh class |
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| − | = Presentation = |
+ | == Presentation == |
* Asymptomatic in 10% |
* Asymptomatic in 10% |
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* Hypothermia (15%) |
* Hypothermia (15%) |
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| − | = Investigations = |
+ | == Investigations == |
* Labs |
* Labs |
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* Other |
* Other |
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| − | = Management = |
+ | == Management == |
* 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 == |
* In-hospital mortality of about 33% in hospital |
* In-hospital mortality of about 33% in hospital |
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Revision as of 11:27, 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
