Spontaneous bacterial peritonitis (patient information)

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 * Assistant Editor-in-Chief: Meagan E. Doherty

Overview
Spontaneous bacterial peritonitis (SBP) is a form of peritonitis that occurs in patients with cirrhosis. It occurs in 10-30% of hospitalized patients with ascites, and can cause marked decompensation of the liver disease, with other complications and death occurring frequently. Peritonitis is swelling (inflammation) of the peritoneum -- the tissue that lines the wall of the abdomen and covers the abdominal organs.

What are the symptoms of Spontaneous bacterial peritonitis?
Symptoms of Spontaneous bacterial peritonitis include:
 * Abdominal pain and bloating
 * Abdominal tenderness
 * Fever
 * Fluid in the abdomen
 * Low urine output

Other symptoms include:
 * Chills
 * Joint pain
 * Nausea and vomiting

What causes Spontaneous bacterial peritonitis?
Spontaneous peritonitis is usually caused by ascites, a collection of fluid in the peritoneal cavity. This usually occurs from liver or kidney failure. Risk factors for liver disease include alcoholic cirrhosis and other diseases that lead to cirrhosis, such as viral hepatitis (Hepatitis B or C). Spontaneous peritonitis also occurs in patients who are on dialysis for kidney failure.

Who is at highest risk?
Risk Factors include:
 * patients who have liver or kidney failure
 * patients who are on dialysis for kidney failure
 * patients with cirrhosis

Diagnosis
Tests that show infection:
 * Blood culture
 * Cell studies (cytologic examination) of peritoneal fluid
 * Chemical examination of peritoneal fluid
 * Culture of peritoneal fluid
 * Peritoneal fluid analysis (paracentesis)

Other tests:
 * Abdominal imaging studies (to rule out other causes of abdominal pain)
 * WBC (nuclear) scan

When to seek urgent medical care?
Call your health care provider if you have symptoms of peritonitis. This can quickly become an emergency situation.

Treatment options
Treatment depends on the cause of the peritonitis.
 * Surgery may be needed if peritonitis is caused by a foreign object, such as a catheter used in peritoneal dialysis.
 * Antibiotics may control infection in cases of spontaneous peritonitis with liver or kidney disease.
 * Intravenous therapy can treat dehydration.

You may need to stay in the hospital so health care providers can rule out other causes of peritonitis, such as appendicitis and diverticulitis.

Diseases with similar symptoms

 * Peritoneal carcinomatosis
 * Pancreatic ascites
 * Tuberculous ascites

Where to find medical care for Spontaneous bacterial peritonitis?
Directions to Hospitals Treating Spontaneous bacterial peritonitis

Prevention of Spontaneous bacterial peritonitis
Patients with peritoneal catheters should be treated with sterile techniques. In cases of liver failure, antibiotics may help prevent peritonitis from coming back.

What to expect (Outlook/Prognosis)?
The infection can usually be treated. However, kidney or liver disease may limit recovery.

Possible complications

 * Abscess
 * Hepatic encephalopathy
 * Hepatorenal syndrome
 * Intestinal obstruction from scar tissue
 * Sepsis