Spontaneous bacterial peritonitis

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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[edit | edit source]

  • 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[edit | edit source]

  • 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[edit | edit source]

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

Therapy[edit | edit source]

  • 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[edit | edit source]

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

Links[edit | edit source]

Related Articles [ modify | edit source ][edit | edit source]

Bibliography[edit | edit source]

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