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Complications of Ascites
Spontaneous bacterial peritonitis.(SBP)
Hyponatremia.
Refractory ascites.
Hepatorenal syndrome(HRS)
THE MOST COMMON COMPLICATION IS:
SBP (Spontaneous Bacterial Peritonitis)
Definition SBP
Spontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without an evident intraabdominal surgically-treatable source.
Risk factor SBP
- Severity of underlying liver disease
- Large volume ascites
- Low protein ascites
- GI bleeding
- Prior SBP
SBP
~...of all cirrhotic patients with ....:
50% on ...
50% during ....
-20% , ascites
-admission
-in hospital stay
Symptoms
SBP
-Fever, abdominal Pain
-Liver function impairment
-Hepatic Encephalopathy
-Renal failure
-asymptomatic / oligosymptomatic
Etiology SBP
The cause of SBP has not been established definitively but is believed to involve ..... spread of organisms in a patient in whom a diseased ... and altered.....result in a defect in the usual filtration function.
-hematogenous
-liver
- portal circulation
opsonization
process whereby opsonins make an invading microorganism more susceptible to phagocytosis
SBP: Diagnosis =
Puncture !
Puncture every cirrhotic patient immediately after admission to the hospital and during hospital stay when having
-local symptoms
-Signs of systemic infection
-Encephalopathy or renal failure
-GI-Bleeding, before prophylactic AB-therapy
Diagnosis SBP
-Cell count and differential: Neutrophils in Ascites >250/µL
-Bacterial culture of ascites in blood culture bottles (min. 10mL)
-Same time blood culture
bacteria isolated from ascitic fluid with patient having SBP
-eschericia coli (most)
-klebsiella pneumonia
-streptococcus pneumoniae
-other type of strept.
-enterobacteriaceae
-stapyhlococcu
-pseudomonas
Classification of Ascitic Fluid Infection
-Spontaneous bacterial peritonitis (SBP)
-Culture-negative neutrocytic ascites (CNNA)
-Monomicrobial non-neutrocytic bacterascites (NNBA)
-Polymicrobial bacterascites
Spontaneous bacterial peritonitis (SBP)
Ascitic fluid culture :Positive
Absolute PMN/ mm3 :≥ 250
Culture-negative neutrocytic ascites (CNNA)
Ascitic fluid culture :No growth
Absolute PMN/ mm3 :≥ 250
Monomicrobial non-neutrocytic bacterascites (NNBA)
Ascitic fluid culture :Positive
Absolute PMN/ mm3 :< 250
Polymicrobial bacterascites
Ascitic fluid culture :Positive
Absolute PMN/ mm3 :≥ 250
D/D from secondary bacterial peritonitis :
In SBP, a .... organism is typically isolated; ..... are found less frequently in SBP than in secondary peritonitis, in which a .... flora including anaerobes is the rule.

In fact, if SBP is suspected and ..... organisms including anaerobes are recovered from the peritoneal fluid, the diagnosis must be reconsidered and a source of ....... sought.
In SBP, a single organism is typically isolated; anaerobes are found less frequently in SBP than in secondary peritonitis, in which a mixed flora including anaerobes is the rule.

In fact, if SBP is suspected and multiple organisms including anaerobes are recovered from the peritoneal fluid, the diagnosis must be reconsidered and a source of secondary peritonitis sought