Ascites and Spontaneous Bacterial Peritonitis
Arthur Harris, MDAttending, Division of Gastroenterology
Jacobi Medical Center/North Central Bronx HospitalAssistant Professor of Medicine, AECOM
Latest Physiopathology
• Increased resistance to hepatic flow
• Portal hypertension
• Production of splanchnic arterial vasodilators (NO)
• Early cirrhosis
• Late cirrhosis
Consequences of vasodilatation
• Decreased effective plasma volume
• Sodium retentionSodium retention
• Increased capillary permeability
Ascites – Patient Evaluation
• Assess liver function
• Evaluation of renal and CVS function
• Ascitic fluid analysis
• Endoscopy for varices
Therapy
It’s all about the sodium
Spontaneous Bacterial Peritonitis
SBP – Antibiotic Therapy I• Initiate for PMN≥250/mm3
• IV Cefotaxime 2g q8 hours or Ceftriaxone 2g q24hours
• Duration of therapy unclear– 2 weeks suggested if Blood cultures(+)
– If repeat paracentesis at 48 hours shows PMN≤250/mm3, then 5-7 days of treatment may be adequate
SBP – Antibiotic Therapy II
• Prophylactic antibiotics should also be prescribed indefinitely until ascites has eliminated
• Options include:
-Bactrim DS 1 tab po 5 days/week
-Cipro 750mg po q week