Pathophysiology: Mechanism unknown but thought to occur via enteric seeding or
hematogenous spread.
90% are Gm-ve Rods (mainly E coli)
Presentation: Asymptomatic in 30% of
patients.
-Fever .
-Abdominal pain +/-
rebound.*
-jaundice
-Altered mental status
especially if sudden deterioration (hepatic vs infectious encephalopathy)*.
-Ileus*
DX:
- Importance is to do
urgent Paracentesis in a presenting patient
DDx: r/o intracranial
pathology
Laboratory:Ascitic neutrophil count of >500 is the single best
predictor of SBP. Determine the SAAG to
evaluate for portal HTN. Often Gm stain and Cx’s are negative but 70% are GNR.
Cytology should be sent to rule out malignancy. An ascites lactate level of >30 mg/dL is 100% sensitive and
specific in predicting active SBP
in a retrospective analysis. Urine an and Bcx’s (35% of time positive).
Abdominal x-ray to
distinguish from perforation
Treatment:
1-Third generation
cephalosporins such as cefotaxime (2gm IV q 8hrs) is recommended.
2- IV albumin on day 1
and day 3 increases survival (NEJM 1999; 341:403)
3- Prophylaxis in
Cirrhotic patients is important (quinolone/bactrim)