Spontaneous bacterial peritonitis: Difference between revisions
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==Background== |
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*Primary infection of the ascitic fluid, diagnosed by ascites fluid with positive culture or with neutrophil count greater than 250 |
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=== Microbiology === |
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===Pathophysiology=== |
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== Bacteriology == |
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===Risk Factors=== |
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*Previous history of SBP |
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*[[Upper GI bleed]] |
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*Low sciatic protein |
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*Child-Pugh class |
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==Clinical Manifestations== |
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*Asymptomatic in 10% |
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*Fever (70%) |
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*Abdominal pain (60%) |
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*Hepatic encephalopathy (50%) |
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*Abdominal tenderness, usually without rigidity (50%) |
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*Diarrhea (30%) |
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*Ileus (30%) |
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*Shock (20%) |
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*Hypothermia (15%) |
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=== Prognosis and Complications === |
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== Investigations == |
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* Labs |
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** Ascitic fluid for cell count and culture |
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* Imaging |
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* Other |
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==Investigations== |
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*Diagnostic paracentesis with ascitic fluid sent for cell count with differential and culture |
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* Acute |
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* Chronic |
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==Management== |
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== Prevention == |
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[[Category:Intra-abdominal infections]] |
[[Category:Intra-abdominal infections]] |
Revision as of 17:34, 20 August 2020
Background
- Primary infection of the ascitic fluid, diagnosed by ascites fluid with positive culture or with neutrophil count greater than 250
Microbiology
- Escherichia coli (43%)
- Klebsiella pneumoniae (11%)
- Streptococcus pneumoniae (9%)
- Other streptococcal species (19%)
- Enterobacteriaceae (4%)
- Staphylococcus (3%)
- Pseudomonas (1%)
- Miscellaneous (10%)
- Aeromonas hydrophila, in Korea
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
Risk Factors
- Previous history of SBP
- Upper GI bleed
- Low sciatic protein
- Child-Pugh class
Clinical Manifestations
- 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%)
Prognosis and Complications
- In-hospital mortality of about 33% in hospital
- 58% 6-month mortality
Investigations
- Diagnostic paracentesis with ascitic fluid sent for cell count with differential and culture
- Neutrophil count < 250 rules it out
- Culture usually monomicrobial
- Repeat paracentesis at 48h if ongoing concern
Management
- Ceftriaxone 1-2g IV q24h
Prevention
- Prophylaxis is indicated after even a single episode of SBP
- TMP-SMX SS PO daily
- Norfloxacin
- Possibly a role for primary prophylaxis