It is infection of the peritoneum & ascitic fluid, which occurs in the absence of any intra- abdominal source of infection. It usually occurs in people who have cirrhosis & portal HTN
RISK FACTORS:
- Previous episode of SBP
- Very low proteins in the ascitic fluid
Which Bacteria?:
- E.Coli
- Klebsiella
- Pneumococci
How it presents?
- Mild abdominal pain & tenderness
- Worsening of ascites
- Mild fever
- Encephalopathy *Any cirrhosis patient who gets worsening of his ascites or develops encephalopathy ⇒ rule out SBP by paracentesis *
DIAGNOSIS: Do paracentesis
- Neutrophil count in ascitic fluid: more than 250cells/uL
- Send fluid for Gram stain & culture: But Gram stain can be negative, so don’t depend on it.
Please remember the neutrophil count ! It is diagnostic even if Gram stain is negative. If the neutrophils are less than 250/uL, it is not called S.B.P. even if bacteria are present in Gram Stain.
Treatment:
- i.v. antibiotics (3rd generation cephalosporins like ceftazidime, cefotaxime.
- Alternatives are i.v ciprofloxacin, norfloxacin.
After the first episode of SBP, patients should take lifelong antibiotic, either Ciprofloxacin or norfloxacin, for secondary prophylaxis.
So , remember 2 complications of ascites:
* SBP
* Respiratory distress