Spontaneous Bacterial Peritonitis

00:01 Spontaneous Bacterial Peritonitis I find that many students get this confused and they are exactly sure when to choose this as being the diagnosis.

00:10 Let's take a look at first the risk factor for SBP.

00:15 Recent gastrointestinal hemorrhage.

00:18 Ascitic fluid less than 1 gram.

00:21 In other words, there is Ascitis taking place. Therefore, Remember, the peritoneal cavity has not been compromised.

00:28 There is every possibility that the fluid within the peritoneal cavity may then become infected.

00:34 We call this Spontaneous Bacterial Peritonitis.

00:38 The name pretty much tells you exactly what's going on with this risk factors.

00:42 And there might be prior episodes of SBP - Spontaneous Bacterial Peritonitis.

00:49 Microbiologically, the gram negative organisms will play a role 70% of the time if not greater. That is extremely concerning.

00:57 You might have Streptococci the gram positive organisms.

01:00 often times though however, you might find, polymicrobial infection therefore suggesting that the origin of the Spontaneous Bacterial Peritonitis might have been the bowel that then perforated.

01:11 How? What if it was diverticular disease? which is extremely common in the U.S.

01:17 Where diverticulosis, diverticulitis and with enough inflammation, a rapture, there's every possibility that it might result in Spontaneous Bacterial Peritonitis.

01:30 Clinical presentation: Severe abdominal pain, fever, and perhaps encephalopathy if the issue took place and originated from the liver.

01:40 Diagnosis: With ascitic fluid, in which you expect "Aperitonitis" you can expect your neutrophils to be quite high bedside inoculation of ascetic fluid into blood culture bottles increases your yield.

01:57 There, that way, immediately you can tell as to whether not your patient is suffering from SBP.

02:02 Something that you very much want to keep in mind, when the patient is suffering from ascites.

02:07 Management, third generation cephalosporin.

02:10 Albium replacement is indicated in patients with renal dysfunction, patients with high bilirubin levels typically greater than 4 Or after a large volume paracentesis, greater than 5 liters.

02:21 Aditionally, discontinuing non-selective beta-blockers such as propranolol is absolutely necessary.

02:28 And phrophylaxis with Co-trimoxazole, sulfamethoxazole and Trimethoprim.