Spontaneous Bacterial Peritonitis (SBP)
Consider in ALL cirrhotics - Revathi Jyothindran MD
image by: Hepatic
HWN Recommends
A Case for the Early Tap: Spontaneous Bacterial Peritonitis
It can occur in patients OTHER THAN those with cirrhosis (nephrotic syndrome patients, for example), and has a high mortality. This is where we can actually make a difference - by making the diagnosis early. Every hour of delayed diagnosis (and then delayed treatment) raises mortality by 3%.
So if you are suspicious of it, TAP THAT BELLY. And you have to have a high degree of suspicion because up to 10% of patients with SBP will not have signs and symptoms of it!
Resources
Albumin for Patients with SBP or Large-Volume Paracentesis
... the AASLD recommendation is to administer albumin (1.5 g/kg within 6 hours of diagnosis of SBP followed by 1.0 g/kg on day 3) in patients with a serum creatinine > 1 mg/dL OR BUN > 30 mg/dL OR bilirubin > 4 mg/dL. It should be noted that the limited administration based on these laboratory abnormalities is based on a single observational cohort study, and seems somewhat arbitrary.
Spontaneous Bacterial Peritonitis – Pearls & Pitfalls
SBP is commonly a part of the differential diagnosis in patients with a history of cirrhosis and ascites. However, the classic symptoms of fever, abdominal pain, and worsening ascites are rare.
A Case for the Early Tap: Spontaneous Bacterial Peritonitis
It can occur in patients OTHER THAN those with cirrhosis (nephrotic syndrome patients, for example), and has a high mortality.
CMC Compendium
The count is what counts. % segs x total nucleated cells = absolute PMN count > = 250 cells per mm3 -gram stain is highly inaccurate with 40 % FP rate -culture is also only positive 40 % of the time.
EMCrit
Spontaneous Bacterial Peritonitis (SBP) Consider using a very thin lumbar puncture needle (e.g., a 24-gague needle)...
Life in the Fastlane
Incidence 20% in those with ascites admitted to hospital
NuemBlog.com
Prompt paracentesis is the key to proper management. It is considered safe to perform diagnostic paracentesis in all patients but those with evident hyperfibrinolysis or those in DIC.
RebelEM
SBP is a difficult diagnosis to make because presentations are variable. Consider a diagnostic paracentesis in all patients presenting to the ED with ascites from cirrhosis.
WikEM
Portal hypertension → bowel edema → normal flora translocates across bowel wall into the peritoneum.
Introducing Stitches!
Your Path to Meaningful Connections in the World of Health and Medicine
Connect, Collaborate, and Engage!
Coming Soon - Stitches, the innovative chat app from the creators of HWN. Join meaningful conversations on health and medical topics. Share text, images, and videos seamlessly. Connect directly within HWN's topic pages and articles.
