This MedLibrary.org supplementary page on Spontaneous bacterial peritonitis is provided directly from the open source Wikipedia as a service to our readers. Please see the note below on authorship of this content, as well as the Wikipedia usage guidelines. To search for other content from our encyclopedia supplement, please use the form below:
Related Sponsors
| Spontaneous bacterial peritonitis Classification and external resources |
|
| ICD-9 | 567.23 |
|---|---|
| eMedicine | emerg/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.
Contents |
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 neutrophils > 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.[1]
Prevention/screening
All cirrhotic patients might benefit from antibiotics if:
- Ascitic fluid protein <1.0 g/dL[2]. Patients with fluid protein <15 g/L and either Child-Pugh score of at least 9 or impaired renal function may also benefit.[3]
- Previous SBP[4]
Cirrhotic patients admitted to the hospital should receive antibiotics if:
- They have bleeding esophageal varices[5]
References
- ^ Sort P, Navasa M, Arroyo V, et al (1999). "Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis". N. Engl. J. Med. 341 (6): 403–9. doi:. PMID 10432325.
- ^ Runyon BA (1986). "Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis". Gastroenterology 91 (6): 1343–6. PMID 3770358.
- ^ Fernández J, Navasa M, Planas R, et al (2007). "Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis". Gastroenterology 133 (3): 818–24. doi:. PMID 17854593.
- ^ Grangé JD, Roulot D, Pelletier G, et al (1998). "Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind randomized trial". J. Hepatol. 29 (3): 430–6. PMID 9764990.
- ^ Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L (2002). "Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding". Cochrane database of systematic reviews (Online) (2): CD002907. doi:. PMID 12076458.
Wikipedia content modification information:
- This page was last modified on 6 July 2008, at 06:18.
Wikipedia Authorship and Review
Wikipedia content provided here is not reviewed directly by MedLibrary.org. Wikipedia content is authored by an open community of volunteers and is not produced by or in any way affiliated with MedLibrary.org.
Wikipedia Usage Guidelines
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article on "Spontaneous bacterial peritonitis".
The URL for this specific entry is:
All Wikipedia text is available under the terms of the GNU Free Documentation License. (See Copyrights for details). Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc.