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==Overview==
{{DiseaseDisorder infobox |
{{DiseaseDisorder infobox |
   Name        = Spontaneous bacterial peritonitis|
   Name        = Spontaneous bacterial peritonitis|
   ICD10      = |
   ICD10      = |
   ICD9        = {{ICD9|567.23}} |
   ICD9        = {{ICD9|567.23}} |
   eMedicineSubj  = emerg |
   eMedicineSubj  = |
   eMedicineTopic = 882 |
   eMedicineTopic = |
}}
}}
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{{Spontaneous bacterial peritonitis}}
'''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.
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==Symptoms==
==[[Spontaneous bacterial peritonitis overview|Overview]]==
Symptoms include fevers, chills, nausea, vomiting, abdominal tenderness and general malaise. Patients may complain of abdominal pain and worsening [[ascites]]. It is important to emphasize, though, that [[hepatic encephalopathy]] may be the ''only'' manifestation of SBP, especially in people with [[cirrhosis]] and [[ascites]]. Indeed, in the absence of a clear precipitant for the encephalopathy, all patients should undergo [[paracentesis]] with a view towards ruling SBP in or out.


==Diagnosis==
==[[Spontaneous bacterial peritonitis classification|Classification]]==
Diagnosis necessitates [[paracentesis]] (needle drainage of the ascitic fluid) and laboratory confirmation of ascitic [[neutrophil]]s > 250/mm<sup>3</sup>.
 
==[[Spontaneous bacterial peritonitis historical perspective|Historical Perspective]]==
 
==[[Spontaneous bacterial peritonitis pathophysiology|Pathophysiology]]==
 
==[[Spontaneous bacterial peritonitis epidemiology and demographics|Epidemiology & Demographics]]==
 
==[[Spontaneous bacterial peritonitis epidemiology and demographics|Risk Factors]]==
 
==[[Spontaneous bacterial peritonitis screening|Screening]]==


==Treatment==
==[[Spontaneous bacterial peritonitis causes|Causes]]==
===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, norfloxicin) as long as they still have [[ascites]].


===Intravenous albumin===
==[[Spontaneous bacterial peritonitis differential diagnosis|Differentiating Spontaneous bacterial peritonitis from other Diseases]]==
A [[randomized controlled trial]] found that intravenous albumin on the day of admission and on hospital day 3 can reduce  renal impairment.<ref name="pmid10432325">{{cite journal |author=Sort P, Navasa M, Arroyo V, ''et al'' |title=Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis |journal=N. Engl. J. Med. |volume=341 |issue=6 |pages=403-9 |year=1999 |pmid=10432325 |doi=}}</ref>


==Prevention/screening==
==[[Spontaneous bacterial peritonitis natural history|Natural History, Complications & Prognosis]]==
All cirrhotic patients might benefit from antibiotics if:
* Ascitic fluid protein <1.0 g/dL<ref name="pmid3770358">{{cite journal |author=Runyon BA |title=Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis |journal=Gastroenterology |volume=91 |issue=6 |pages=1343-6 |year=1986 |pmid=3770358 |doi=}}</ref>. Patients with fluid protein <15 g/L and either Child-Pugh score of at least 9 or impaired renal function may also benefit.<ref name="pmid17854593">{{cite journal |author=Fernández J, Navasa M, Planas R, ''et al'' |title=Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis |journal=Gastroenterology |volume=133 |issue=3 |pages=818–24 |year=2007 |pmid=17854593 |doi=10.1053/j.gastro.2007.06.065}}</ref>
* Previous SBP<ref name="pmid9764990">{{cite journal |author=Grangé JD, Roulot D, Pelletier G, ''et al'' |title=Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind randomized trial |journal=J. Hepatol. |volume=29 |issue=3 |pages=430-6 |year=1998 |pmid=9764990 |doi=}}</ref>


Cirrhotic patients admitted to the hospital should receive antibiotics if:
==Diagnosis==
* They have bleeding [[esophageal varices]]<ref name="pmid12076458">{{cite journal |author=Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L |title=Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding |journal=Cochrane database of systematic reviews (Online) |volume= |issue=2 |pages=CD002907 |year=2002 |pmid=12076458 |doi=}}</ref>
[[Spontaneous bacterial peritonitis history and symptoms|History & Symptoms]] | [[Spontaneous bacterial peritonitis physical examination|Physical Examination]] | [[Spontaneous bacterial peritonitis staging|Staging]] | [[Spontaneous bacterial peritonitis laboratory tests|Lab Tests]] | [[Spontaneous bacterial peritonitis electrocardiogram|Electrocardiogram]] | [[Spontaneous bacterial peritonitis chest x ray|Chest X Ray]] | [[Spontaneous bacterial peritonitis CT|CT]] | [[Spontaneous bacterial peritonitis MRI|MRI]] | [[Spontaneous bacterial peritonitis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Spontaneous bacterial peritonitis other imaging findings|Other Imaging Findings]] | [[Spontaneous bacterial peritonitis other diagnostic studies|Other Diagnostic Studies]]


==References==
==Treatment==
<references/>
[[Spontaneous bacterial peritonitis medical therapy|Medical Therapy]] | [[Spontaneous bacterial peritonitis surgery|Surgery]] | [[Spontaneous bacterial peritonitis primary prevention|Primary Prevention]] | [[Spontaneous bacterial peritonitis secondary prevention|Secondary Prevention]]


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[[pl:Spontaniczne bakteryjne zapalenie otrzewnej]]
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[[Category:Gastroenterology]]
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[[Category:Hepatology]]
[[pl:Spontaniczne bakteryjne zapalenie otrzewnej]]
[[Category:Infectious disease]]


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Revision as of 16:07, 2 February 2012

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