SBP

Today we talked about a young patient who came in with abdominal pain and encephalopathy in the setting of cirrhosis and ascites.

See the previous post on the approach to this patient's Ascites from block 2



Today we discussed the importance of considering SBP on the differential when:
- any cirrhotic pt is admitted to the hospital (regardless of reason)
- pt wiht ascites has a GI bleed
-pt with ascites  has abdo pain, nausea/vomiting/diarrhea, leukocytosis, encephlopathy

thus do a diagnostic tap
look for: Ascites PMN > 250 or WBC > 500 

BUT--If WBC > 1000 or polymicrobial culture or protein > 10g/L, suspect secondary peritonitis, perforation, abscess etc

Treatment of SBP includes antibiotics (3rd gen cephlosporin or cipro) and albumin if renal failure is a concern (see this NEJM article on use of albumin in SBP)