The following is an excerpt....
BASICS
Description
- Infection of ascites fluid without an evident intra-abdominal surgically treatable source:
- Ascites polymorphonuclear leukocyte count >250/mL with a positive bacterial ascites culture
- Must be distinguished from secondary bacterial peritonitis:
- Nonsurgical management of secondary bacterial peritonitis carries 100% mortality.
- Surgical management of spontaneous bacterial peritonitis (SBP) carries 80% mortality.
Etiology
- Mechanism:
- Portal hypertension causes translocation of overgrown bacteria through edematous gut mucosa to lymph nodes to the peritoneal cavity.
- Transient bacteremia with low serum complement
- Impaired activity of reticuloendothelial system phagocytosis and opsonization
- Can also seed ascitic fluid via bacteremia from infections outside of the gut
- Usually seen in the setting of cirrhosis:
- Rare in other conditions causing ascites (nephrotic syndrome or CHF)
- Predominant organisms:
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