Spont Bact Peritonitis

[kbrown]

Do you have to have ascites to have SBP? I had a HCV pt with abd pain, vomiting and no ascites. Rest of work up was negative, but pt had persistent abd pain, mild leukocytosis with toxic granulation on diff, LFT's were pts baseline, lactate negative. My first concern was SBP, but she had no ascites on exam and ultimately on CT. It would have been very difficult and dangerous to tap her belly w/o any fluid collection to enter into. Just curious.

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[Apollyon]

The ascites are the culture medium for the SBP, so it makes it much easier. In other words, I suspect that it is unlikely but very possible to have SBP with minimal or no ascites.

 

[StudentDoc327]

Had a patient with SBP recently and remember the article in uptodate I read saying patients almost certainly have to have ascites to get SBP, but there have been a few cases in children where this was not so. But then again i'm only a preliminary intern so the extend of my knowledge is UTD.

 

[DrQuinn]

You know, I have aggressively looked for SBP, and think I have only found it once. Actually two weeks ago. FINALLY caught one. Gram Negative Rods, too. Kinda cool.

Q

 

[BadVB750]

Is fever usually present?

 

[beyond all hope]

Cirrhotic patients, like AIDS patients, chemo patients and malnourished alcoholics, are severely immune compromised. Any little infection will make them septic and kill them. That's why we hunt for infection if there's even the slightest chance that it's there.

I have NEVER seen SBP by neutrophil count but I've tapped and treated for it multiple times (sometimes the cultures are positive later). With US, you can tap a very small amount of fluid for analysis.

Do you need ascites to have SBP? I don't know. Do you need ascites to diagnose SBP? In my book, yes. Otherwise you just end up with a septic cirrhosis patient with no known source. So, I hope that answers your question.

 

[Caffiend_79]

I don't think you need frank ascites to have SBP. However, if your peritoneal lining is severely inflammed you will usually have some finding on CT, either peritoneal enhancement/thickening or stranding of the omentum/peri-peritoneal fat.