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Spontaneous bacterial bacterial (SBP) (Risk factors (GI bleeds, Low…
Spontaneous bacterial
bacterial (SBP)
Definition
Bacterial infection of ascitic
fluid in the peritoneum
Epidemiology
10-30% hospitalised
patients with ascites
Pathophysiology
Ascites
Impaired antimicrobial activity
Bacterial translocation from gut
Microbiology
E Coli most common
Also Klebsiella, streps
Risk factors
GI bleeds
Low ascitic protein
Advanced liver disease
Previous SBP
Clinical
presentation
Ascites
Fever
Abdo pain
Diagnosis
Examination
General: pale, generally unwell
Abdo: signs of CLD, decompensation (ascites, caput medusae, encephalopathy), rebound tender, shifting dull
Investigations
Bedside
Obs (high HR, low BP, pyrexia)
ECG (sinus tachycardia)
Bloods
FBC (high WCC), CRP (high),
U+Es, LFTs (deranged),
clotting (may be deranged)
Blood cultures
Microbiology
Ascitic tap
WCC - high
Protein - low
MCS - organism
History
PC: abdo pain/tenderness, ascites, fever
PMH: liver disease, ascites, previous SBP
DH: current meds (antibiotics), allergies
SH: smoking, alcohol, drugs
Management
Initial ABCDE
Definitive
Conservative
Monitoring (obs)
Hydration and nutrition
Refer to gastro
Medical
Antibiotics
E.g. cephalosporin (cefotaxime),
quinolone (ciprofloxacin)
Prevention
Abx prophylaxis
Quinolone e.g. norfloxacin, ciprofloxacin