{"id":2531,"date":"2009-03-05T11:28:06","date_gmt":"2009-03-05T11:28:06","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/infsbp\/"},"modified":"2025-05-14T19:10:56","modified_gmt":"2025-05-14T19:10:56","slug":"infsbp","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/infsbp\/","title":{"rendered":"Diagnosis of Spontaneous Bacterial Peritonitis (SBP)"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>Spontaneous bacterial peritonitis (SBP) is a frequent complication in cirrhotic patients with ascites. Diagnosis of SBP is established by a polymorphonuclear cell count in ascitic fluid &gt; or =250 cells\/mm(3).<!--more--><\/p>\n<p class=\"MsoNormal\">Indications for diagnostic paracentesis.<\/p>\n<ul>\n<li class=\"MsoNormal\">Cirrhotic patients with ascites at admission<\/li>\n<li class=\"MsoNormal\">Cirrhotic patients with ascites and signs or symptoms of infection: fever, leukocytosis, abdominal pain<\/li>\n<li class=\"MsoNormal\">Cirrhotic patients with ascites who present with a clinical condition that is deteriorating during hospitalization: renal function impairment, hepatic encephalopathy, gastrointestinal bleeding<\/li>\n<li class=\"MsoNormal\">Patients with new-onset ascites<\/li>\n<\/ul>\n<p class=\"MsoNormal\"><strong>Analysis of Peritoneal Fluid<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"width: 33.7576%;\"><strong><span style=\"color: black;\">Test and Ascitic-Fluid Container<\/span><\/strong><\/td>\n<td style=\"width: 66.2424%;\"><strong><span style=\"color: black;\">Comments<\/span><\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.7576%;\">Albumin<\/td>\n<td style=\"width: 66.2424%;\"><span style=\"color: #000000;\">Differential diagnosis of ascites according to the serum\u2013ascites albumin gradient<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.7576%;\">Cell<\/td>\n<td style=\"width: 66.2424%;\">Cell count and differential count<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 33.7576%;\">Culture<\/td>\n<td style=\"width: 66.2424%;\">Aerobic- and anaerobic-culture<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p class=\"MsoNormal\"><strong><span style=\"color: black;\">Additional Analyses of Ascitic Fluid<\/span><\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%; height: 312px;\" border=\"1\">\n<tbody>\n<tr style=\"height: 24px;\">\n<td style=\"width: 33.7576%; height: 24px;\"><strong><span style=\"color: black;\">Test and Ascitic-Fluid Container<\/span><\/strong><\/td>\n<td style=\"width: 66.2424%; height: 24px;\"><strong><span style=\"color: black;\">Comments<\/span><\/strong><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 33.7576%; height: 24px;\" colspan=\"2\"><strong><span style=\"color: black;\">Tube without additives<\/span><\/strong><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 33.7576%; height: 24px;\"><span style=\"color: black;\">Total protein<\/span><\/td>\n<td style=\"width: 66.2424%; height: 24px;\">Values <span style=\"text-decoration: underline;\"> &gt;<\/span>1 g\/dl suggest secondary peritonitis instead of SBP<\/td>\n<\/tr>\n<tr style=\"height: 48px;\">\n<td style=\"width: 33.7576%; height: 48px;\"><span style=\"color: black;\">Lactate dehydrogenase<\/span><\/td>\n<td style=\"width: 66.2424%; height: 48px;\"><span style=\"color: black;\">Values greater than the upper limit of normal for serum suggest secondary peritonitis instead of SBP<\/span><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 33.7576%; height: 24px;\"><span style=\"color: black;\">Glucose<\/span><\/td>\n<td style=\"width: 66.2424%; height: 24px;\"><span style=\"color: black;\">Values &lt;50 mg\/dl suggest secondary peritonitis instead of SBP<\/span><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 33.7576%; height: 24px;\"><span style=\"color: black;\">Carcinoembryonic antigen<\/span><\/td>\n<td style=\"width: 66.2424%; height: 24px;\"><span style=\"color: black;\">Values &gt;5 ng\/ml suggest hollow viscus perforation<\/span><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 33.7576%; height: 24px;\"><span style=\"color: black;\">Alkaline phosphatase<\/span><\/td>\n<td style=\"width: 66.2424%; height: 24px;\"><span style=\"color: black;\">Values &gt;240 U\/liter suggest hollow viscus perforation<\/span><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 33.7576%; height: 24px;\"><span style=\"color: black;\">Amylase<\/span><\/td>\n<td style=\"width: 66.2424%; height: 24px;\"><span style=\"color: black;\">Values markedly elevated (often &gt;2000 U\/liter or five times serum levels) in patients with pancreatic ascites or hollow viscus perforation<\/span><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 33.7576%; height: 24px;\"><span style=\"color: black;\">Triglyceride<\/span><\/td>\n<td style=\"width: 66.2424%; height: 24px;\"><span style=\"color: black;\">Values &gt;200 mg\/dl suggest chylous ascites<\/span><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 33.7576%; height: 24px;\" colspan=\"2\"><strong><span style=\"color: black;\">Syringe or evacuated container<\/span><\/strong><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 33.7576%; height: 24px;\"><span style=\"color: black;\">Cytology<\/span><\/td>\n<td style=\"width: 66.2424%; height: 24px;\"><span style=\"color: black;\">Sensitivity increased if three samples submitted and promptly evaluated<\/span><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 33.7576%; height: 24px;\"><span style=\"color: black;\">Mycobacterial culture<\/span><\/td>\n<td style=\"width: 66.2424%; height: 24px;\"><span style=\"color: black;\">Sensitivity only 50%<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p class=\"MsoNormal\"><strong><span style=\"color: black;\">Differential Diagnosis of Ascites According to the Serum\u2013Ascites Albumin Gradient<\/span><\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"width: 50%;\"><strong><span style=\"color: black;\">Gradient\u00a0<\/span><\/strong><span style=\"text-decoration: underline;\">&gt;<\/span><strong><span style=\"color: black;\">1.1 g\/dl (portal hypertension)<\/span><\/strong><\/td>\n<td style=\"width: 50%;\"><strong><span style=\"color: black;\">Gradient &lt;1.1 g\/dl<\/span><\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 50%;\">\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><span style=\"color: black;\">Cirrhosis<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><span style=\"color: black;\">Alcoholic hepatitis<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><span style=\"color: black;\">Cardiac ascites<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><span style=\"color: black;\">Portal-vein thrombosis<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><span style=\"color: black;\">Budd-Chiari syndrome<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><span style=\"color: black;\">Liver metastases<\/span><\/p>\n<\/td>\n<td style=\"width: 50%;\">\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><span style=\"color: black;\">Peritoneal carcinomatosis<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><span style=\"color: black;\">Tuberculous peritonitis<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><span style=\"color: black;\">Pancreatic ascites<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><span style=\"color: black;\">Biliary ascites<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><span style=\"color: black;\">Nephrotic syndrome<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><span style=\"color: black;\">Serositis<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"MsoNormal\">The diagnosis of SBP is suggested by a polymorphonuclear (PMN) cell count in excess of 250 cells per cubic millimeter in the absence of evidence of an alternative source of infection (secondary peritonitis), such as viscus perforation or intraabdominal abscess.<\/p>\n<p class=\"MsoNormal\">Determination of total protein, lactate dehydrogenase, and glucose levels in ascitic fluid may aid in the differentiation between SBP and secondary peritonitis. Culture is used to confirm the diagnosis of SBP.<\/p>\n<p>&nbsp;<\/p>\n<p class=\"MsoNormal\"><strong>References:<\/strong><\/p>\n<div class=\"Section1\">\n<ol>\n<li class=\"MsoNormal\">Fernandez J, Bauer TM, Navasa M, Rodes J. Diagnosis, treatment and prevention of spontaneous bacterial peritonitis. Baillieres Best Pract Res Clin Gastroenterol. 2000 Dec;14(6):975-990. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/11139350\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<li class=\"MsoNormal\">Thomsen TW, Shaffer RW, White B, Setnik GS. Videos in clinical medicine. Paracentesis. N Engl J Med. 2006 Nov 9;355(19):e21. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17093242\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<\/div>\n<div class=\"Section1\"><\/div>\n<div class=\"Section1\">Created: Apr 17, 2007<\/div>\n<div class=\"Section1\"><\/div>\n<p><\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[53],"tags":[1077,1076,123,13,1628,1413,1344,1627,1626,1629],"class_list":["post-2531","post","type-post","status-publish","format-standard","hentry","category-gastroenterology","tag-bacterial","tag-bacteriana","tag-diagnosis","tag-diagnostico","tag-espontanea","tag-gastroenterology","tag-infectious","tag-peritonitis","tag-sbp","tag-spontaneous"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2531","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2531"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2531\/revisions"}],"predecessor-version":[{"id":8951,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2531\/revisions\/8951"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2531"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2531"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2531"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}