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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]
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]
Spontaneous bacterial peritonitis (SBP) is a peculiar form of peritonitis occurring in the absence of an obvious source of contamination. It occurs in people with ascites, including children. Intra-peritoneal dialysis predisposes to peritoneal infection (sometimes named "primary peritonitis" in this context).
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]
Infections that are common in those in the hospital with cirrhosis include spontaneous bacterial peritonitis (with a prevalence of 27% among hospitalized patients), urinary tract infections (22-29%), pneumonia (19%), spontaneous bacteremia (8-13%), skin and soft tissue infections (8-12%) and C. difficile colitis (2.4-4%).
Portal hypertension is defined as increased portal venous pressure, with a hepatic venous pressure gradient greater than 5 mmHg. [3] [4] Normal portal pressure is 1–4 mmHg; clinically insignificant portal hypertension is present at portal pressures 5–9 mmHg; clinically significant portal hypertension is present at portal pressures greater than 10 mmHg. [5]
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.
In liver disease and cirrhosis, in addition to the above indications, the use of albumin is being considered for bacterial infections other than spontaneous bacterial peritonitis, hepatic encephalopathy, and chronic ascites. Its use in these indications remains controversial. [8]