Improving care in ED
15208254249420Antibiotics: ceftriaxone 2g IV OD or cefotaxime 2g IV TDS; in dialysis patient, antibiotics can be intraperitoneal (ceftazidime and cephazolin initially); vancomycin into CAPD bag used if proven gram +ive infectionOther: manage hepatic encephalopathy; IV albumin 1.5g/kg may help ? renal failure00Antibiotics: ceftriaxone 2g IV OD or cefotaxime 2g IV TDS; in dialysis patient, antibiotics can be intraperitoneal (ceftazidime and cephazolin initially); vancomycin into CAPD bag used if proven gram +ive infectionOther: manage hepatic encephalopathy; IV albumin 1.5g/kg may help ? renal failure2463804249420Management00Management2463803368040Investigation00Investigation15208253368040Paracentesis: macroscopically abnormal in >95%; WCC >1000 (sensitivity 80%); neutrophils >250 (sensitivity >95%, specificity 20%); ? glucose, ? protein; gram stain positive in 10-50% (95% specificity), bacteria rarely grownBloods: cultures positive in 50%; LFTs; FBC00Paracentesis: macroscopically abnormal in >95%; WCC >1000 (sensitivity 80%); neutrophils >250 (sensitivity >95%, specificity 20%); ? glucose, ? protein; gram stain positive in 10-50% (95% specificity), bacteria rarely grownBloods: cultures positive in 50%; LFTs; FBC2463802835910Assessment00Assessment152082528346405% asymptomatic; fever 40% sensitivity; afebrile patients has worst prognosis; abdominal pain in 95%; hepatic encephalopathy in 50%; guarding and rigidity often absent005% asymptomatic; fever 40% sensitivity; afebrile patients has worst prognosis; abdominal pain in 95%; hepatic encephalopathy in 50%; guarding and rigidity often absent15208251951355Infection of ascitic fluid without intra-abdominal focus; ascitic fluid has low levels of complement and opsonic activity; ? risk if low protein ascitesE coli 30%; Grp D enterococci 15%; other staph 15%; staph aureus 10%; klebsiella 10%; pseudomonas 5%; anaerobes 5%; 10% >1 organism00Infection of ascitic fluid without intra-abdominal focus; ascitic fluid has low levels of complement and opsonic activity; ? risk if low protein ascitesE coli 30%; Grp D enterococci 15%; other staph 15%; staph aureus 10%; klebsiella 10%; pseudomonas 5%; anaerobes 5%; 10% >1 organism2463801951355Patho-physiology00Patho-physiology2463801487170Risk Factors00Risk Factors15195551487170Hepatic cirrhosis, nephrotic syndrome, peritoneal dialysis00Hepatic cirrhosis, nephrotic syndrome, peritoneal dialysis246380964565Epidemiology00Epidemiology1520190961390High mortality (for 1st episode – 68% survival at 1/12, 30% survival t 3/12); 30% of ascetic patients will develop SBP in 1 year00High mortality (for 1st episode – 68% survival at 1/12, 30% survival t 3/12); 30% of ascetic patients will develop SBP in 1 year246380330200Spontaneous Bacterial Peritonitis (SBP)00Spontaneous Bacterial Peritonitis (SBP) ................
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