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Spontaneous bacterial peritonitis

Última revisão: 11 Jun 2025
Última atualização: 13 Feb 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • abdominal pain or tenderness
  • signs of ascites
  • fever
  • nausea/vomiting
  • diarrhea
  • altered mental status
  • gastrointestinal bleed
Detalhes completos

Outros fatores diagnósticos

  • hypothermia
  • hypotension
  • tachycardia
Detalhes completos

Fatores de risco

  • decompensated hepatic state (usually cirrhosis)
  • low ascitic protein/complement
  • gastrointestinal bleeding
  • endoscopic sclerotherapy for esophageal varices
  • ascites due to malignancy, renal insufficiency, or congestive heart failure
  • extraintestinal infection
  • invasive procedures
  • use of proton-pump inhibitors (PPIs)
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • CBC
  • serum creatinine
  • LFT
  • prothrombin time/INR
  • blood cultures
  • ascitic fluid appearance
  • ascitic fluid absolute neutrophil count (ANC)
  • ascitic fluid culture
  • ascitic fluid protein, glucose, lactate dehydrogenase (LDH), pH
Detalhes completos

Investigações a serem consideradas

  • serum-ascites albumin gradient (SAAG)
  • ascitic fluid carcinoembryonic antigen (CEA)
  • ascitic fluid alkaline phosphatase
  • ascitic fluid AFB stain and culture, fungal culture, microscopy for ova/parasites
  • ascitic fluid lactoferrin
  • CT scan abdomen
Detalhes completos

Novos exames

  • highly-sensitive leukocyte esterase reagent strip testing of ascitic fluid (Periscreen)
  • bedside (standard urine) leukocyte esterase reagent strip testing of ascitic fluid

Algoritmo de tratamento

AGUDA

community-acquired infection with low risk for resistant species

nosocomial infection, septic shock, high risk for MDR organisms

Colaboradores

Autores

Brian Chinnock, MD

Associate Professor of Emergency Medicine

UCSF Fresno Medical Education Program

Fresno

CA

Declarações

BC is an author of references cited in this topic.

Revisores

Ke-Qin Hu, MD

Director, Hepatology Services, H.H. Chao Comprehensive Digestive Disease Center

Professor of Medicine

School of Medicine

University of California, Irvine

Irvine

CA

Declarações

KQH declares that he has no competing interests.

Andrea De Gottardi, MD, PhD

Visiting Hepatologist

Hepatic Hemodynamic Laboratory

Liver Unit

Hospital Clinic

Barcelona

Spain

Declarações

ADG declares that he has no competing interests.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Aug;74(2):1014-48.Texto completo  Resumo

European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018 Aug;69(2):406-60.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Spontaneous bacterial peritonitis images
  • Diagnósticos diferenciais

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    • Intraperitoneal hemorrhage into ascitic fluid
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  • Diretrizes

    • Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)
    • Use of albumin infusion for cirrhosis-related complications: an international position statement
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  • Folhetos informativos para os pacientes

    Ascitic tap and ascitic drain procedures

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