Spontaneous bacterial peritonitis history and symptoms: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Spontaneous bacterial peritonitis}} | {{Spontaneous bacterial peritonitis}} | ||
{{CMG}}; {{AE}} {{ | {{CMG}}; {{AE}}{{SCh}}; {{AY}} | ||
==Overview== | ==Overview== | ||
The main manifestations of [[ | The main manifestations of [[SBP]] are acute [[abdominal tenderness|abdominal pain]], [[abdominal tenderness|tenderness]], [[fever]]. Symptoms may be masked in the elderly and ~30% may be asymptomatic. Patients may also complain of worsening [[ascites]]. [[hepatic encephalopathy]] may be the ''only'' manifestation of SBP, especially in people with [[cirrhosis]] and [[ascites]]. The clinical presentation of SBP is highly variable as it may manifest as a relatively insidious colonization without signs and symptoms or it can rapidly develop as a [[Septicaemia|septic syndrome]].<ref name="HoefsRuyon1985">{{cite journal|last1=Hoefs|first1=John C.|last2=Ruyon|first2=B.A.|title=Spontaneous bacterial peritonis|journal=Disease-a-Month|volume=31|issue=9|year=1985|pages=1–48|issn=00115029|doi=10.1016/0011-5029(85)90002-1}}</ref> | ||
==History== | ==History== | ||
A directed history should be obtained to ascertain the precipitant of this condition | A directed history should be obtained to ascertain the precipitant of this condition, detailed history has to be obtained regarding: | ||
* Previous episodes of SBP. | * Previous episodes of SBP. | ||
* Associated conditions as [[ | * Associated conditions as [[portal Hypertension]], [[ cirrhosis]], [[ascites]], [[variceal bleeding]]. | ||
* Signs and symptoms of infection such as new-onset [[ | * Signs and symptoms of infection such as new-onset [[fever]] (greater than 37.8°C or 100°F), [[abdominal pain]], [[confusion]], [[hepatic encephalopathy]], [[metabolic acidosis]], [[renal failure]], [[hypotension]], [[diarrhea]], [[paralytic ileus]], [[hypothermia]], [[leukocytosis]] in a [[Cirrhosis|cirrhotic]] patient should prompt an evaluation of the [[Ascites|ascitic fluid]] for spontaneous bacterial peritonitis (SBP). | ||
* Any [[renal disease]] and/or [[heart disease]]. | * Any [[renal disease]] and/or [[heart disease]]. | ||
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* Onset of symptoms and their progression. | * Onset of symptoms and their progression. | ||
* Hospitalizations, | * Hospitalizations, alcohol intake, [[hepatitis]]. | ||
* Invasive procedures, | * Invasive procedures, instrumentation including a history of [[Peritoneal dialysis]]. | ||
* Presence of B-symptoms such as night | * Presence of B-symptoms such as [[night sweats]], [[malaise]], [[weight loss]]. | ||
* Immune-deficiencies like [[HIV]]. | * [[Immunodeficiency|Immune-deficiencies]] like [[HIV]]. | ||
* Use of [[ | * Use of [[Proton pump inhibitor|PPIs]] and [[beta-adrenergic antagonists]]. | ||
* Family history of | * Family history of [[liver disease]]. | ||
* History of [[respiratory]] and [[urinary tract infections]]. | * History of [[respiratory]] and [[urinary tract infections]]. | ||
==Common Symptoms == | ==Common Symptoms == | ||
Some of the common symptoms of SBP include:<ref name="pmid9798013">{{cite journal| author=Such J, Runyon BA| title=Spontaneous bacterial peritonitis. | journal=Clin Infect Dis | year= 1998 | volume= 27 | issue= 4 | pages= 669-74; quiz 675-6 | pmid=9798013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9798013 }} </ref> | Some of the common symptoms of SBP include:<ref name="pmid9798013">{{cite journal| author=Such J, Runyon BA| title=Spontaneous bacterial peritonitis. | journal=Clin Infect Dis | year= 1998 | volume= 27 | issue= 4 | pages= 669-74; quiz 675-6 | pmid=9798013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9798013 }} </ref><ref name="pmid23473819">{{cite journal| author=Chinnock B, Hendey GW, Minnigan H, Butler J, Afarian H| title=Clinical impression and ascites appearance do not rule out bacterial peritonitis. | journal=J Emerg Med | year= 2013 | volume= 44 | issue= 5 | pages= 903-9 | pmid=23473819 | doi=10.1016/j.jemermed.2012.07.086 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23473819 }} </ref> | ||
* [[Fever]]<ref name="urlPeritonitis - spontaneous: MedlinePlus Medical Encyclopedia">{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000648.htm |title=Peritonitis - spontaneous: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref> | * [[Fever]]<ref name="urlPeritonitis - spontaneous: MedlinePlus Medical Encyclopedia">{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000648.htm |title=Peritonitis - spontaneous: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref> | ||
* Worsening of pre-existing ascites and progressive [[encephalopathy]] in a patient with cirrhotic ascites | * Worsening of pre-existing [[ascites]] and progressive [[encephalopathy]] in a patient with [[Ascites|cirrhotic ascites]] | ||
* Diffuse, continuous [[ | * Diffuse, continuous [[abdominal pain]] may be present and few patients may be asymptomatic. | ||
* [[Altered mental status]] may manifest as frank [[delirium]], [[confusion]] | * [[Altered mental status]] may manifest as frank [[delirium]], [[confusion]] or cognitive slowing. | ||
* [[Diarrhea]] | * [[Diarrhea]] | ||
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* [[Obstipation]] | * [[Obstipation]] | ||
* Low urine output | * [[Low urine output]] | ||
* Thirst | * Thirst | ||
* Fatigue | * [[Fatigue]] | ||
* Chills | * Chills | ||
* [[Dizziness]] or weakness | |||
* [[ | |||
* [[Breathlessness]] may be due to [[infection]], [[fluid overload]] or underlying heart condition | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
Latest revision as of 00:15, 30 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Ahmed Younes M.B.B.CH [3]
Overview
The main manifestations of SBP are acute abdominal pain, tenderness, fever. Symptoms may be masked in the elderly and ~30% may be asymptomatic. Patients may also complain of worsening ascites. hepatic encephalopathy may be the only manifestation of SBP, especially in people with cirrhosis and ascites. The clinical presentation of SBP is highly variable as it may manifest as a relatively insidious colonization without signs and symptoms or it can rapidly develop as a septic syndrome.[1]
History
A directed history should be obtained to ascertain the precipitant of this condition, detailed history has to be obtained regarding:
- Previous episodes of SBP.
- Associated conditions as portal Hypertension, cirrhosis, ascites, variceal bleeding.
- Signs and symptoms of infection such as new-onset fever (greater than 37.8°C or 100°F), abdominal pain, confusion, hepatic encephalopathy, metabolic acidosis, renal failure, hypotension, diarrhea, paralytic ileus, hypothermia, leukocytosis in a cirrhotic patient should prompt an evaluation of the ascitic fluid for spontaneous bacterial peritonitis (SBP).
- Any renal disease and/or heart disease.
- Onset of symptoms and their progression.
- Hospitalizations, alcohol intake, hepatitis.
- Invasive procedures, instrumentation including a history of Peritoneal dialysis.
- Presence of B-symptoms such as night sweats, malaise, weight loss.
- Immune-deficiencies like HIV.
- Use of PPIs and beta-adrenergic antagonists.
- Family history of liver disease.
- History of respiratory and urinary tract infections.
Common Symptoms
Some of the common symptoms of SBP include:[2][3]
- Worsening of pre-existing ascites and progressive encephalopathy in a patient with cirrhotic ascites
- Diffuse, continuous abdominal pain may be present and few patients may be asymptomatic.
- Altered mental status may manifest as frank delirium, confusion or cognitive slowing.
- Development of ileus paralyticus (i.e. intestinal paralysis), which also causes nausea and vomiting
Less common symptoms of SBP
- Thirst
- Chills
- Dizziness or weakness
- Breathlessness may be due to infection, fluid overload or underlying heart condition
References
- ↑ Hoefs, John C.; Ruyon, B.A. (1985). "Spontaneous bacterial peritonis". Disease-a-Month. 31 (9): 1–48. doi:10.1016/0011-5029(85)90002-1. ISSN 0011-5029.
- ↑ Such J, Runyon BA (1998). "Spontaneous bacterial peritonitis". Clin Infect Dis. 27 (4): 669–74, quiz 675-6. PMID 9798013.
- ↑ Chinnock B, Hendey GW, Minnigan H, Butler J, Afarian H (2013). "Clinical impression and ascites appearance do not rule out bacterial peritonitis". J Emerg Med. 44 (5): 903–9. doi:10.1016/j.jemermed.2012.07.086. PMID 23473819.
- ↑ "Peritonitis - spontaneous: MedlinePlus Medical Encyclopedia".