Spontaneous bacterial peritonitis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Spontaneous bacterial peritonitis (SBP) is one of the most frequently encountered bacterial infections in patients with cirrhosis, and most commonly seen in patients with end-stage liver disease.
Key symptoms are abdominal pain, fever, vomiting, altered mental status, and gastrointestinal bleeding. However, patients are commonly minimally symptomatic, and may even be asymptomatic.
Ascitic fluid laboratory tests should include cell count and culture. Bedside (standard urine) leukocyte esterase reagent strip testing of ascitic fluid has a role in the rapid diagnosis of spontaneous bacterial peritonitis (SBP); highly-sensitive leukocyte esterase reagent strip testing of ascitic fluid may be used to rule out SBP.
Defined by an ascitic fluid absolute neutrophil count >250 cells/mm³, whether or not there is culture growth.
Treatment is directed primarily at early administration of appropriate empirical antibiotic regimens. The practitioner must be aware of local resistance patterns, with particular reference to increased third-generation cephalosporin and fluoroquinolone resistance.

Abdominal ultrasound showing large amount of ascites with bowel loops

From the personal collection of Brian Chinnock, MD; used with permission

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Definition

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Images

Algorithm for the diagnosis of spontaneous bacterial peritonitis (absolute neutrophil count [ANC]; lactate dehydrogenase [LDH]; carcinoembryonic antigen [CEA])
Abdominal ultrasound showing large amount of ascites with bowel loops

Citations

Key Articles

Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Aug;74(2):1014-48.[Abstract][Full Text]
European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018 Aug;69(2):406-60.[Abstract][Full Text]
McGibbon A, Chen GI, Peltekian KM, et al. An evidence-based manual for abdominal paracentesis. Dig Dis Sci. 2007 Dec;52(12):3307-15.[Abstract]

Referenced Articles

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