Spontaneous Bacterial Peritonitis

Question 1

Define spontaneous bacterial peritonitis.

Answer 1

Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid that cannot be attributed to any intra-abdominal, ongoing inflammatory, or surgically correctable condition. It is one of the most frequently encountered bacterial infections in patients with cirrhosis.

Question 2

Explain the aetiology/risk factors of spontaneous bacterial peritonitis.

Answer 2

Decompensated hepatic state (usually cirrhosis)
Low ascitic protein/complement
GI bleeding
Sclerosis of oesophageal varices

Question 3

Summarise the epidemiology of spontaneous bacterial peritonitis.

Answer 3

Studies have demonstrated a SBP prevalence of 12% in patients with ascites admitted for decompensated cirrhosis, 18% in those admitted for hepatic encephalopathy, and 10% to 14% in those admitted with acute GI haemorrhage.

Question 4

Recognise the presenting symptoms of spontaneous bacterial peritonitis. Recognise the signs of spontaneous bacterial peritonitis on physical examination.

Answer 4

Abdominal pain or tenderness
Signs of ascites
Fever
Nausea/vomiting
Diarrhoea
Altered mental status
GI bleed
Hypothermia
Hypotension
Tachycardia

Question 5

Identify appropriate investigations for spontaneous bacterial peritonitis and interpret the results.

Answer 5

FBC
Serum creatinine
Ascitic fluid appearance
Ascitic fluid absolute neutrophil count (ANC)
Ascitic fluid Gram stain
Ascitic fluid culture
Highly-sensitive leukocyte esterase reagent strip testing of ascitic fluid (Periscreen)
Bedside (standard urine) leukocyte esterase reagent strip testing of ascitic fluid
Blood cultures
LFT
PT/INR
Ascitic fluid pH and arterial blood pH

Question 6

Generate a management plan for spontaneous bacterial peritonitis.

Answer 6

Antibiotics
Antibiotic and beta-blocker prophylaxis

Question 7

Identify the possible complications of spontaneous bacterial peritonitis and its management.

Answer 7

Sepsis/septic shock
Tense ascites
Bleeding after paracentesis
Bowel perforation after paracentesis
Leakage from paracentesis puncture site
Renal failure

Question 8

Summarise the prognosis for patients with spontaneous bacterial peritonitis.

Answer 8

One-year SBP recurrence rates as high as 69% have been reported. Randomised controlled trials comparing antibiotic regimens have described an in-hospital mortality rate of 10% to 28%.