What causes spontaneous bacterial peritonitis?

Spontaneous bacterial peritonitis can occur when bacteria that normally live in the intestine enter the abdominal cavity and the ascites becomes infected. This happens in advanced liver disease because the immune system response weakens and the bacterial environment in the gut changes.

What bacteria causes spontaneous bacterial peritonitis?

Escherichia coli, streptococci (mostly pneumococci), and Klebsiella cause most episodes of spontaneous bacterial peritonitis in patients who are not receiving selective intestinal decontamination (Garcia-Tsao 1992).

What is spontaneous bacterial peritonitis?

Spontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without an evident intra-abdominal surgically treatable source [1].

How do you rule out spontaneous bacterial peritonitis?

The diagnosis of SBP is established based on positive ascitic fluid bacterial cultures and the detection of an elevated absolute fluid polymorphonuclear neutrophil (PMN) count in the ascites (>250/mm3) without an evident intra-abdominal surgically treatable source of infection [1, 9].

What are the symptoms of spontaneous bacterial peritonitis?

Spontaneous bacterial peritonitis (SBP) is one of the most frequently encountered bacterial infections in patients with cirrhosis, and most commonly seen in patients with end-stage liver disease. Key symptoms are abdominal pain, fever, vomiting, altered mental status, and gastrointestinal bleeding.

Who is at risk for spontaneous bacterial peritonitis?

Patients who are at high risk for SBP include: Patients with gastrointestinal bleed and cirrhosis. Patients who already had SBP one or more times in the past. Cirrhotic patients with ascites in which ascitic fluid protein is < 1.5 g/dl along with renal failure (creatinine > 1.2 mg/dl).

When do you rule out SBP?

To rule out the possible presence of SBP, a paracentesis tap should also be repeated in all ascitic cirrhotic patients with gastrointestinal bleeding or hepatic encephalopathy, and whenever patients develop clinical symptoms and signs of infection, renal impairment or an unexplained worsening of their clinical …

What is the pathophysiology of peritonitis?

Peritonitis is most often caused by introduction of an infection into the otherwise sterile peritoneal environment through organ perforation, but it may also result from other irritants, such as foreign bodies, bile from a perforated gall bladder or a lacerated liver, or gastric acid from a perforated ulcer.

What is the pathophysiology of bacterial peritonitis?

The most important pathogenic mechanism for SBP is bacterial translocation. In liver cirrhosis, three mechanisms are proposed for the pathogenesis of SBP: intestinal bacterial overgrowth, the alterations (structural and functional) of the intestinal mucosal barrier and the deficiencies of the local immune response.

How is SBP spontaneous bacterial peritonitis diagnosed?

The diagnosis of SBP is established by a positive ascitic fluid bacterial culture, an elevated ascitic fluid absolute polymorphonuclear leukocyte (PMN) count (≥250 cells/mm3), and exclusion of secondary causes of bacterial peritonitis.