Spontaneous Bacterial Peritonitis - Dr. Jyothindran

Spontaneous Bacterial Peritonitis
- defined as infection of ascitic fluid with no obvious surgically removable source
- high mortality - 40% at first onset, 70% two year mortality
- usually caused by translocation of gut bacteria, GNBs ( E Coli) or GPC (streptococcus sp. etc)
- Consider in ALL cirrhotics! 
- Check for ascites with U/S if you have to.

Abdominal Paracentesis:
- Paracentesis has very low 5% risk of bleeding which can be avoided by ultrasound
- Only 0.6% risk of infection from bowel injury during the procedure or iatrogenic introduction
- Fluid Labs: order protein, count, gram stains and culture
     -The count is what counts. % segs  x total nucleated cells = absolute PMN count > = 250 cells per mm3
     -gram stain is highly inaccurate with 40 % FP rate
     -culture is also only positive 40 % of the time
     -culture negative neutrophilic ascites and SBP should be treated the same

Treatment:
- Antibiotics : Ceftriaxone 2g per day or Cefotaxime 2g per 6 h
- Albumin : 1.5 g/kg in first six hours and 1 g/kg on day 3

Renal Dysfunction:
- high correlation with mortality
- hepatorenal syndrome - type 1 is acute and more lethal
- Reduction in mortality from 29% to 10% with use of albumin

SBP Prophylaxis : in GI bleeders, those with previous SBP and also those with low protein ascitic fluid  and no history of SBP