Spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis is a bacterial infection of the ascites without any detectable or surgically treatable source of the infection. This is a common complication of ascites (30%) of cirrhotic origin.

Etiology and pathogenesis

• The source of the infection is probably the intestine - the infection passes through the intact intestinal wall through translocations
• ascites with low opsonic activity are more susceptible to spontaneous bacterial peritonitis,
• infectious agents are mostly facultative anaerobic gram negative intestinal bacteria: E. coli, Klebsiella, Enterobacter, Proteus.

Clinical manifestation

• Signs are variable + mostly insignificant,
• infection can manifest with ↑ accumulation of the ascites + failure of the diuretic treatment, or with the liver insufficiency,
• subfebrile temperature + diffuse abdominal pain,
• often manifest after the bleeding of the esophageal varices,
• untreated bacterial peritonitis has lethality about 30 %.

Diagnostics

• Diagnostic paracentesis with ascites examination: cultivation, leukocytes > 0,4 x 10⁹/l → start treatment.

Therapy

• Cephalosporins of the third generation (cefotaxime, 2 g every 8 hours), albumin (prevention of the hypovolemia - hepatorenal syndrome),
• selective intestinal decontamination with the non-absorbable antibiotics (norfloxacin 400 g) – prevention.

Prognosis

• Poor (relapse, worsening of liver + renal function).

Links

Related Articles [ modify | edit source ]

• Portal hypertension
• Consequences of portal hypertension
• Ascites
• Hepatorenal syndrome
• Peritonitis

Bibliography

• DÍTĚ, P., et al. Vnitřní lékařství. 2. edition. Praha : Galén, 2007. ISBN 978-80-7262-496-6.