Spontaneous bacterial peritonitis (SBP)
Epidemiology of SBP
- SBP occurs in 10-30% of patients with ascites and has mortality rate of 20%
- Organisms are usually E. coli, streptococci and enterococci.
Symptoms of spontaneous bacterial peritonitis (SBP)
- Generalised abdominal pain
- Hepatic encephalopathy, renal impairment or peripheral leucocytosis without any obvious precipitating factor.
Video on the diagnosis and management of SBP
Investigations in suspected SBP
- Diagnostic paracentesis (click here to learn how to do a diagnostic paracentesis)
- Mandatory in all patients with cirrhosis requiring hospital admission
- Ascitic fluid contains >250 cells/mm.
Treatment spontaneous bacterial peritonitis (SBP)
- Prompt broad spectrum iv antibiotics
- e.g. Tazocin 4.5g three times daily
- Treat as soon as ascitic tap has been sent if high index for suspicion
- If fluid resuscitation needed for septic shock then try to avoid colloid/crystalloid and use plasma expander such as human albumin solution instead.
- Good evidence for prophylactic antibiotics after one episode of SBP
- E.g. Ciprofloxacin 250mg twice daily
Click here to download free teaching notes on Decompensated chronic liver disease: Spontaneous bacterial peritonitis (SBP)
Perfect revision for medical students, finals, OSCEs and MRCP PACES