Spontaneous bacterial peritonitis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Shivani Chaparala M.B.B.S [3]

Overview

The main manifestations of SBP are acute abdominal pain, tenderness, fever, chills, nausea, vomiting, abdominal pain. Symptoms may be masked in the elderly and ~30% may be asymptomatic. Patients may also complain of 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. Lastly, the clinical presentation of SBP is highly variable as this condition may manifest as a relatively insidious colonization – without signs and symptoms or it can rapidly develop as a septic syndrome.

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 history of Peritoneal Dialysis.

• Presence of B-symptoms such as night-sweats, malaise, weight loss.

• Immune-deficiencies like HIV.

• Use of PPI's 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:

• Fever

• 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.

• Diarrhea

• Development of ileus paralyticus (i.e. intestinal paralysis), which also causes nausea and vomiting

Less common symptoms of SBP

• Bloating

• Anorexia

• Obstipation

• Low urine output

• Thirst

• Fatigue

• Chills

• Dizziness or weakness

• Breathlessness may be due to infection, fluid overload or underlying [[heart condition]

References

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