SBP

Question 1

Indications of prophylaxis against SBP

Answer 1

A-Patients at high risk of SBP:
ƒ Ascitic fluid protein < 1.5 g/dL and at least one of the following:
o Serum creatinine ≥ 1.2 mg/dL, Blood urea nitrogen ≥ 25 mg/dL, serum sodium ≤ 130 meq/L
o Child-Pugh ≥ 9 points with bilirubin ≥ 3 mg/dL
B- Patients with a prior history of documented SBP.
C- Patients with cirrhosis and gastrointestinal bleeding.

Question 2

Recommended prophylactic regimen

Answer 2

*Norfloxacin 400mg once daily or trimethoprim-sulfamethoxazole one double-strength tablet once daily.
* IV ceftriaxone given in GI bleeding

Question 3

Treatment of SBP

Answer 3

Antibiotics -Albumin
1-Antibiotics
Empirical Antibiotic Therapy (start immediately after diagnosis):
*First-line:
IV Cefotaxime 2 g every 8 hours
OR Ceftriaxone 1–2 g IV daily
for 7days
*Alternative options (especially for β-lactam allergies):
IV fluoroquinolones (e.g., ciprofloxacin or levofloxacin)

Question 4

Treatment of SBP

Answer 4

2-Albumin Infusion

*Reduces risk of renal impairment and mortality.
*Recommended for high-risk patients:
Serum creatinine >1 mg/dL, BUN >30 mg/dL, or total bilirubin >4 mg/dL
*Regimen:

1.5 g/kg on day 1

1.0 g/kg on day 3

Question 5

Treatment of SBP

Answer 5

3. Monitor and Adjust

Repeat paracentesis in 48 hours if clinical improvement is unclear.

Adjust antibiotics based on culture and sensitivity results.

Question 6

Forms of ascetic fluid infections

Answer 6

1. Spontaneous Bacterial Peritonitis (SBP)

*Most common and serious form.

Ascitic PMN ≥250 cells/mm³
+
Positive culture
+
No surgically treatable intra-abdominal source of infection

Question 7

Forms of ascetic fluid infections

Answer 7

2. Culture-Negative Neutrocytic Ascites (CNNA)

*Similar to SBP but ascitic fluid culture is negative.
*PMN ≥250 cells/mm³
*Treated the same as SBP.
عشان كده أول لما تلاقي الخلايا اكتر من ٢٥٠ تبتدي علاج علي طول

Question 8

Forms of ascetic fluid infections

Answer 8

3. Monomicrobial Non-Neutrocytic Bacterascites (MNB)
   Positive culture for one organism
   PMN <250 cells/mm³

Question 9

Forms of ascetic fluid infections

Answer 9

4-Polymicrobial Bacterascites
Positive cultures for multiple organisms
PMN <250 cells/mm³

Question 10

Forms of ascetic fluid infections

Answer 10

5. Secondary Bacterial Peritonitis
   *Caused by an intra-abdominal surgically treatable source (e.g., perforated viscus).
   *Ascitic PMN ≥250 cells/mm³, polymicrobial culture, and high protein, LDH, low glucose.
   *Needs imaging and usually surgical intervention.

Question 11

كده بقي تقدر تقول ما هو SBP

Answer 11

An infection of ascitic fluid without intra-abdominal surgically treatable source, occurring most commonly in patients with cirrhosis and ascites.

Question 12

Diagnostic Criteria of SBP

Answer 12

Ascitic fluid polymorphonuclear leukocyte (PMN) count ≥ 250 cells/mm³, with or without a positive culture.
+
No evidence of a secondary cause of peritonitis (e.g., perforated viscus, abscess).