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Spontaneous Bacterial Peritonitis

 Syn. Primary bacterial peritonitis , SBP , PBP

Signs & Symptoms

 Diffuse pain
Ref: Uptodate [ Clinical manifestations of spontaneous bacterial peritonitis]
Fever
Note: patients with advanced cirrhosis are mildly hypothermic. Thus, a temperature of 37.8ºC or greater must be very seriously
Ref: Uptodate [ Clinical manifestations of spontaneous bacterial peritonitis] Harrison [ 953] Cecil [ 462]
Acute onset of symptoms
Ref: Harrison [ 953]
Worsening renal function
Ref: Uptodate [ Clinical manifestations of spontaneous bacterial peritonitis] Cecil [ 462]

Physical Examination

 Peritoneal irritation
Ref: Harrison [ 953] Cecil [ 462]
Exacerbation of preexisting hepatic encephalopathy
Ref: Harrison [ 285]
Acute onset of symptoms
Ref: Harrison [ 953]

Lab / Serology

 Positive ascitic fluid bacterial culture
Ref: Uptodate [ Clinical manifestations of spontaneous bacterial peritonitis]
Aspirated ascitic fluid has greater than 250 neutrophils
Ref: Harrison [ 2413] Cecil [ 897]
Elevated ascitic fluid absolute polymorphonuclear leukocyte
Note: ≥250 cells/mm3
Ref: Uptodate [ Clinical manifestations of spontaneous bacterial peritonitis]

Imagin Study

 Ascites
Note: always predates infection
Ref: Uptodate [ Clinical manifestations of spontaneous bacterial peritonitis] Harrison [ 953]

Complication

 Multisystem organ failure #Advanced_SBP
Ref: Uptodate [ Clinical manifestations of spontaneous bacterial peritonitis]
Shock #Advanced_SBP
Ref: Uptodate [ Clinical manifestations of spontaneous bacterial peritonitis]

Risk Factors

 Cirrhosis
Ref: Epocrates [ https://online.epocrates.com/diseases/79332/Spontaneous-bacterial-peritonitis/Risk-Factors]

Cause

 Caused by cirrhosis
Ref: Uptodate [ Clinical manifestations of spontaneous bacterial peritonitis] Harrison [ 953]
Caused by endogenous bacteria
Ref: Harrison [ 955]

Other