Spontaneous Bacterial Peritonitis (SBP) Clinical Presentation

Updated: Mar 23, 2021
  • Author: Thomas E Green, DO, MPH, CPE, MMM, FACEP, FACOEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
  • Print


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


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.