Spontaneous Bacterial Peritonitis (SBP)

Exam Cram

• Infection of ascites in liver patients, commonly by E.coli

• Presentation: vague malaise, fevers, oliguria, anorexia; o/e abdominal tenderness

• Investigation: ascitic aspirate WCC > 500 (sometimes > 250)

• Management

  • • • • IV Ceftriaxone or IV Tazocin: cipro + metro (pen allergy)

        • Human albumin solution + IVF

        • Septic screen

Plan

Investigations

1. Ascitic aspirate vs drain, sending samples for

   1. • Cytology

      • Gram staining

      • Microscopy, culture & sensitivity

      • Albumin, protein, LDH, glucose, WCC

2. Septic screen: blood cultures, CXR, urine culture, FBC, EUC, LFTs, Coag, respiratory PCR

3. Monitor UO, aim MAP > 65

Management

4. Antibiotics e.g. ceftriaxone

5. Human albumin 1.5mg/kg for 3d

   1. • E.g. 70kg = 100mg, 20% HAS 100mls 1hr x5 for 3d

6. Alcohol withdrawal scale/ thiamine if alcoholic cause

Housekeeping

7. Admit Gastro / Gen Med

8. VTE: as per guidelines if PLT > 50, e.g. if weight > 50kg, enoxaparin 40mg OD

9. Escalation status

10. Caution paracetamol & nsaids in ALD

11. Addiction services if keen

Written 2024