Spontaneous bacterial peritonitis
986465
223866024
2008-07-06T06:18:27Z
Rhcastilhos
4438862
{{DiseaseDisorder infobox |
Name = Spontaneous bacterial peritonitis|
ICD10 = |
ICD9 = {{ICD9|567.23}} |
eMedicineSubj = emerg |
eMedicineTopic = 882 |
}}
'''Spontaneous bacterial peritonitis''' (SBP) is a form of [[peritonitis]] that occurs in patients with [[cirrhosis]]. It occurs in 10-30% of hospitalized patients with [[ascites]], and can cause marked decompensation of the liver disease, with other complications and death occurring frequently.
==Symptoms==
Symptoms include fevers, chills, nausea, vomiting, abdominal tenderness and general malaise. Patients may complain of abdominal pain and worsening [[ascites]]. [[Hepatic encephalopathy]] may be the only manifestation of SBP; in the absence of a clear precipitant for the encephalopathy, all patients should undergo [[paracentesis]], or sampling of the ascites fluid, in order to assess for SBP.
==Diagnosis==
Diagnosis necessitates [[paracentesis]] (needle drainage of the ascitic fluid) and laboratory confirmation of ascitic [[neutrophil]]s > 250/mm³.
==Treatment==
===Antibiotics===
After confirmation of SBP, patients need hospital admission for intravenous antibiotics (most often [[cefotaxime]] given as 1gm/12hours for 5 days or [[ceftriaxone]]). They will often also receive intravenous albumin. A repeat paracentesis in 48 hours is sometimes performed to ensure control of infection. Once patients have recovered from SBP, they require regular prophylactic antibiotics (e.g. Septra DS, Cipro, [[norfloxacin]]) as long as they still have [[ascites]].
===Intravenous albumin===
A [[randomized controlled trial]] found that intravenous albumin on the day of admission and on hospital day 3 can reduce renal impairment.<ref name="pmid10432325">{{cite journal |author=Sort P, Navasa M, Arroyo V, ''et al'' |title=Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis |journal=N. Engl. J. Med. |volume=341 |issue=6 |pages=403–9 |year=1999 |pmid=10432325 |doi=10.1056/NEJM199908053410603}}</ref>
==Prevention/screening==
All cirrhotic patients might benefit from antibiotics if:
* Ascitic fluid protein <1.0 g/dL<ref name="pmid3770358">{{cite journal |author=Runyon BA |title=Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis |journal=Gastroenterology |volume=91 |issue=6 |pages=1343–6 |year=1986 |pmid=3770358 |doi=}}</ref>. Patients with fluid protein <15 g/L and either Child-Pugh score of at least 9 or impaired renal function may also benefit.<ref name="pmid17854593">{{cite journal |author=Fernández J, Navasa M, Planas R, ''et al'' |title=Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis |journal=Gastroenterology |volume=133 |issue=3 |pages=818–24 |year=2007 |pmid=17854593 |doi=10.1053/j.gastro.2007.06.065}}</ref>
* Previous SBP<ref name="pmid9764990">{{cite journal |author=Grangé JD, Roulot D, Pelletier G, ''et al'' |title=Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind randomized trial |journal=J. Hepatol. |volume=29 |issue=3 |pages=430–6 |year=1998 |pmid=9764990 |doi=}}</ref>
Cirrhotic patients admitted to the hospital should receive antibiotics if:
* They have bleeding [[esophageal varices]]<ref name="pmid12076458">{{cite journal |author=Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L |title=Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding |journal=Cochrane database of systematic reviews (Online) |volume= |issue=2 |pages=CD002907 |year=2002 |pmid=12076458 |doi=10.1002/14651858.CD002907}}</ref>
==References==
{{reflist|2}}
{{Gastroenterology}}
[[Category:Gastroenterology]]
[[pl:Spontaniczne bakteryjne zapalenie otrzewnej]]
[[pt:Peritonite bacteriana espontânea]]