ascites and spontaneous bacterial peritonitis

Ascites and Spontaneous Bacterial Peritonitis

Arthur Harris, MDAttending, Division of Gastroenterology

Jacobi Medical Center/North Central Bronx HospitalAssistant Professor of Medicine, AECOM

Latest Physiopathology

• Increased resistance to hepatic flow

• Portal hypertension

• Production of splanchnic arterial vasodilators (NO)

• Early cirrhosis

• Late cirrhosis

Consequences of vasodilatation

• Decreased effective plasma volume

• Sodium retentionSodium retention

• Increased capillary permeability

Ascites – Patient Evaluation

• Assess liver function

• Evaluation of renal and CVS function

• Ascitic fluid analysis

• Endoscopy for varices

Therapy

It’s all about the sodium

Spontaneous Bacterial Peritonitis

SBP – Antibiotic Therapy I• Initiate for PMN≥250/mm3

• IV Cefotaxime 2g q8 hours or Ceftriaxone 2g q24hours

• Duration of therapy unclear– 2 weeks suggested if Blood cultures(+)

– If repeat paracentesis at 48 hours shows PMN≤250/mm3, then 5-7 days of treatment may be adequate

SBP – Antibiotic Therapy II

• Prophylactic antibiotics should also be prescribed indefinitely until ascites has eliminated

• Options include:

-Bactrim DS 1 tab po 5 days/week

-Cipro 750mg po q week