Spontaneous Bacterial Peritonitis Clinical Presentation

  • Author: Thomas E Green, DO, MPH, FACOEP, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Dec 7, 2011
 

History

A broad range of signs and symptoms are seen in spontaneous bacterial peritonitis (SBP). A high index of suspicion must be maintained when caring for patients with ascites, particularly those with acute clinical deterioration. Completely asymptomatic cases have been reported in as many as 30% of patients.

Fever and chills occur in as many as 80% of patients. Abdominal pain or discomfort is found in as many as 70% of patients.

Other signs and symptoms may include the following:

  • Worsening or unexplained encephalopathy
  • Diarrhea
  • Ascites that does not improve following administration of diuretic medication
  • Worsening or new-onset renal failure
  • Ileus
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Physical Examination

Abdominal tenderness is found in more than 50% of patients with spontaneous bacterial peritonitis. Findings can range from mild tenderness to overt rebound and guarding. In some cases, the abdominal examination findings mimic an acute intra-abdominal catastrophe requiring emergency surgical evaluation. Physical examination may also disclose hypotension (5-14% of patients) or signs of hepatic failure such as jaundice and angiomata.

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Contributor Information and Disclosures
Author

Thomas E Green, DO, MPH, FACOEP, FACEP  Attending Physician, Emergency Department, Franciscan Saint James Hospital; Assistant Professor and Core Faculty, Emergency Medicine Residency, Chicago College of Osteopathic Medicine at Midwestern University

Thomas E Green, DO, MPH, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Coauthor(s)

Steven M Bandy, MD, FACEP  Adjunct Clinical Professor of Emergency Medicine, Virginia College of Osteopathic Medicine; Staff Physician, Department of Emergency Medicine, Johnston Memorial Hospital; Medical Director, Rejuvenage Medspa; Operational Medical Director, Virginia Operations, Wings Air Rescue Ambulance Service

Steven M Bandy, MD, FACEP is a member of the following medical societies: American Academy of Cosmetic Surgery, American College of Emergency Physicians, and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Lata J, Stiburek O, Kopacova M. Spontaneous bacterial peritonitis: a severe complication of liver cirrhosis. World J Gastroenterol. Nov 28 2009;15(44):5505-10. [Medline]. [Full Text].

  2. Bert F, Noussair L, Lambert-Zechovsky N, Valla D. Viridans group streptococci: an underestimated cause of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Eur J Gastroenterol Hepatol. Sep 2005;17(9):929-33. [Medline].

  3. Cholongitas E, Papatheodoridis GV, Lahanas A, Xanthaki A, Kontou-Kastellanou C, Archimandritis AJ. Increasing frequency of Gram-positive bacteria in spontaneous bacterial peritonitis. Liver Int. Feb 2005;25(1):57-61. [Medline].

  4. [Guideline] Runyon BA. Management of adult patients with ascites due to cirrhosis: an update. Hepatology. Jun 2009;49(6):2087-107. [Medline].

  5. Riggio O, Angeloni S. Ascitic fluid analysis for diagnosis and monitoring of spontaneous bacterial peritonitis. World J Gastroenterol. Aug 21 2009;15(31):3845-50. [Medline]. [Full Text].

  6. Chinnock B, Gomez R, Hendey GW. Peritoneal fluid cultures rarely alter management in patients with ascites. J Emerg Med. Jan 2011;40(1):21-4. [Medline].

  7. Gaya DR, David B Lyon T, Clarke J, Jamdar S, Inverarity D, Forrest EH, et al. Bedside leucocyte esterase reagent strips with spectrophotometric analysis to rapidly exclude spontaneous bacterial peritonitis: a pilot study. Eur J Gastroenterol Hepatol. Apr 2007;19(4):289-95. [Medline].

  8. Runyon BA. Monomicrobial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. Hepatology. Oct 1990;12(4 Pt 1):710-5. [Medline].

 
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