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.
