What is Spontaneous Bacterial Peritonitis?
Spontaneous Bacterial Peritonitis
(SBP) basically refers to an abdominal infection. The presence of infection in the abdomen is mostly without any perceived cause. Patients of cirrhosis of liver with portal hypertension(increased pressure in the main portal vein which drains blood from the gastrointestinal tract and spleen to the liver) are mostly found to have this condition. Such patients also have ascites which is the retention of fluids in the membrane between the abdominal cavity and the abdominal wall.
It can also occur in patients with nephrotic syndrome. Kidney damage can cause large amounts of protein to be leaked from the blood in to the urine.
About 20-30% of patients with cirrhosis of liver and associated ascites develop this condition. In cases of ascites where the total protein retained in the abdominal fluid is below 1g/dL, patients are 10 times more prone to contract the condition.
How is Spontaneous Bacterial Peritonitis caused?
- SBP is caused mainly by enteric gram negative bacteria ( E Coli, Klebsiella Pneumoniae, Enterococcus species) or the gram positive bacteria (Streptococcus pneumonia, viridians streptococci ) These are essentially aerobic bacteria. Anaerobic bacteria are not associated with SBP.
- It was a prevalent idea that bacteria from the gut and other lymph tissues migrated into the retained abdominal fluid and caused the infection.
- Today it is believed, that a long presence of bacteria in blood coupled with low immunity caused by cirrhosis and ascites to be the primary cause of this condition. When a procedure to create a bypass route for blood in case of blockage in the hepatic veins goes wrong, it too could cause the resulting infection to migrate to the abdominal cavity.
Diagnosis of SBP
Diagnosis is mainly done by drawing a fluid sample from the abdomen and testing it for the presence of bacteria or neutrophils (white blood cells).
Symptoms of SBP
- Patients can be without any symptoms.
- An increase in body temperature indicative of infection.
- Chills in the body.
- Nausea and Vomiting.
- Abdominal pain and tenderness.
- A detioraration in existing cirrhosis and ascites.
- Hepatic encephalopathy is a condition in which fluid gets retained in brain tissue and causes mental dysfunction and disorder.
Treatment of Spontaneous Bacterial Peritonitis
The condition is treated by administering intravenous antibiotics like Cefotaxime or Ceftriaxone. The patient undergoes another test of the ascitic fluid to detect the presence of bacteria after the dose of antibiotics is done with.
The patient is also given albumin intravenously to reduce renal impairment.