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Spontaneous bacterial peritonitis (SBP) is the development of a bacterial infection in the peritoneum, despite the absence of an obvious source for the infection. [1] It is specifically an infection of the ascitic fluid – an increased volume of peritoneal fluid. [2] Ascites is most commonly a complication of cirrhosis of the liver. [1]
A count of 250 neutrophils per ml or higher is considered diagnostic for spontaneous bacterial peritonitis. Cultures of the fluid can be taken, but the yield is approximately 40% (72–90% if blood culture bottles are used). Empiric antibiotics are typically started when spontaneous bacterial peritonitis is highly suspected.
Surgery is needed to perform a full exploration and lavage of the peritoneum, as well as to correct any gross anatomical damage that may have caused peritonitis. [21] The exception is spontaneous bacterial peritonitis, which does not always benefit from surgery and may be treated with antibiotics in the first instance.
Complications can include spontaneous bacterial peritonitis. [3] In the developed world, the most common cause is liver cirrhosis. [4] Other causes include cancer, heart failure, tuberculosis, pancreatitis, and blockage of the hepatic vein. [4]
Symptomatic relief may be provided by paracentesis, which may also diagnose spontaneous bacterial peritonitis (SBP) Gastrointestinal endoscopy may be used or patients with suspected peptic ulcer disease Helicobacter pylori testing may also be used; Trial medications may be beneficial for the diagnosis and treatment of:
Examples of indications for albumin infusion include hypoalbuminemia in the context of major surgery such as hepatic resection >40%, nephrotic syndrome in conjunction with diuretics and corticosteroids, spontaneous bacterial peritonitis in combination with antibiotics, and rapidly progressing hepatorenal syndrome (type 1) in combination with ...
As infection (specifically spontaneous bacterial peritonitis) and gastrointestinal hemorrhage are both complications in individuals with cirrhosis, and are common triggers for HRS, specific care is made in early identification and treatment of cirrhotics with these complications to prevent HRS. [5]
A cul-de-sac hernia (also termed a peritoneocele) is a herniation of peritoneal folds into the rectovaginal septum (in females), [2] or the rectovesical septum (in males). The herniated structure is the recto-uterine pouch (pouch of Douglas) in females, [2] or the rectovesical pouch in males.