Spontaneous Bacterial Peritonitis (SBP) Clinical Presentation

Updated: Oct 04, 2017
  • Author: Thomas E Green, DO, MPH, MMM, CPE, FACEP, FACOEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Presentation

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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