Cirrhosis spontaneous bacterial peritonitis

O Portal hypertension is the precipitating factor for the complications of cirrhotic liver disease—ascites, spontaneous bacterial peritonitis (SBP), variceal bleeding, and hepatic encephalopathy. Lowering portal pressure can reduce the complications of cirrhosis and decrease morbidity and mortality. 

Cirrhosis is the progressive replacement of normal hepatic cells by fibrous scar tissue. This scarring is accompanied by the loss of viable hepatocytes, which are the functional cells of the liver. Progressive cirrhosis is irreversible and leads to portal hypertension that is in turn responsible for many of the complications of advanced liver disease. These consequences include (but are not limited to) spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, and variceal bleeding.1... 

Drug therapy for portal hypertension and cirrhosis can alleviate symptoms and prevent complications but it cannot reverse cirrhosis. Drug therapy is available to treat the complications of ascites, varices, spontaneous bacterial peritonitis, hepatic encephalopathy, and coagulation abnormalities. 

Garcia-Tsao G Current management of the complications of cirrhosis and portal hypertension Variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology 2001 120 726-748. 

Runyon BA, Squier SU, Borzio M Transloca-tion of gut bacteria in rats with cirrhosis to mesenteric lymph nodes partially explains the pathogenesis of spontaneous bacterial peritonitis. J Hepatol 1994 21 792-796. 

Runyon BA, Borzio M, Young S, Squier SU, Guarner C, Runyon MA Effect of selective intestinal decontamination with norfloxacin on spontaneous bacterial peritonitis, translocation, and survival in an animal model of cirrhosis. Hepatology 1995,21 1719-1724. 

The use of lUDs in patients with CLD has complicating factors. Owing to reduced hepatic complement synthesis and reticuloendothelial system dysfunction, patients with cirrhosis and ascites are prone to develop repeated episodes of spontaneous bacterial peritonitis (SBP). Historically, the risk of pelvic inflammatory disease (PID) was considered to be increased in lUD users during the first year after insertion, therefore it was thought that the presence of an lUD in approximation with the peritoneal surface in a patient with cirrhotic ascites might lead to SBP... 

Spontaneous bacterial empyema is found in 1-2% of patients with cirrhosis and ascites. The diagnosis is based on a positive bacterial test in the pleural fluid and a WBC count in excess of 250/mm (or a negative bacterial culture with a cell count exceeding 500/mm ) - which is analogous to spontaneous bacterial peritonitis. (105) (s. p. 302)... 

Spontaneous bacterial peritonitis (SBP) (H.O. Conn, 1964, 1971) is the term used to describe bacterially infected ascitic fluid in liver cirrhosis where the exact source of infection or path of infection is not known. 

Arroyo, V., Navasa, M., Rimola, A. Spontaneous bacterial peritonitis in liver cirrhosis. Treatment and prophylaxis. Infection 1994 22 (Suppl. 31) 167-175... 

Dlnis-Rlbeiro, M., Cortez-Pinto, H., Marlnho, R., Valente, A., Ral-mundo, M., Salgado, M.J., Ramalho, F., Alexandrlno, P., Carnelro-de-Moura, M. Spontaneous bacterial peritonitis in patients with hepatic cirrhosis evaluation of a treatment protocol at specialized units. Rev. Espan. Enferm. Dig. 2002 94 478-481... 

Llovet, JJM., Rodrignez-Igleslas, R, Moltlnho, E., Planas, R, Bataller, R., Navasa, M., Menacho, M., Pardo, A., Castells, A., Cabre, E., Arroyo, V., GassnU, MA., Rodes, J. Spontaneous bacterial peritonitis in patients with cirrhosis undergoing selective intestinal decontamination. X Hepatol. 1997 26 88-95... 

Mlhas, A.A., Tonssaint, J., Sh Hsu, H., Dotherow, R, Achord, J.L. Spontaneous bacterial peritonitis in cirrhosis clinical and laboratory features, survival and prognostic indicators. Hepato-Gastroenterol. 1992 39 520- 522... 

Sort, R, Navasa, M., Arroyo, V., Aldeguer, X., Planas, R., Lulz-del-Arbol, L., Castells, L., Vargas, V., Soriano, G., Guevara, M., Gines, R, Rodes, J. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. New Engl. J. Med. 1999 341 403-409... 

Complications such as variceal bleeding, hepatic encephalopathy, ascites and infections as well as reduced renal function also influence the mortality rate of liver cirrhosis (in Germany some 25,000/year). The main causes of death are hepatic coma or liver failure (25-40%), bleeding (20-30%), infections (about 10%) and HCC (about 5%). Spontaneous bacterial peritonitis is fatal in 50-70%, and with liver dysfunction even in 90% of cases. Occurrence of the hepatorenal syndrome is almost invariably fatal. 

The penetration of routinely used fluoroquinolones into ascitic fluid after intravenous administration has been studied in patients with uncompensated hepatic cirrhosis (125). Three patients received three doses of ciprofloxacin 200 mg, six received three doses of ciprofloxacin 300 mg, seven received three doses of pefloxacin 400 mg, and six received three doses of ofloxacin 400 mg. Pefloxacin and ofloxacin produced serum and ascitic fluid concentrations above the MICs of the common pathogens that cause spontaneous bacterial peritonitis, and the authors concluded that... 

Eosinophilia occurred in a 35-year-old man with alcoholic cirrhosis taking norfloxacin 400 mg bd for prophylaxis of spontaneous bacterial peritonitis (5). 

Conn H, Fessel J. Spontaneous bacterial peritonitis in cirrhosis Variations on a theme. Medicine (Baltimore) 1971 50 161-97. 

Llach J, Rimola A, Navasa M, et al. Incidence and predictive factors of first episode of spontaneous bacterial peritonitis in cirrhosis with ascites Relevance of ascitic fluid protein concentration. Hepatology 1992 16 724-727. 

Gines P, Rimola A, Planas R, et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis Results of a double-blind, placebo-controlled trial. Hepatology 1990 12 716-724. 

Llovet J, Rodriguez-lglesias P, Moitinho E, et al. Spontaneous bacterial peritonitis in patients with cirrhosis undergoing selective intestinal decontamination. A retrospective study of 229 spontaneous bacterial peritonitis episodes. J Hepatol 1997 26 88-95. 

Das A. A cost analysis of long-term antibiotic prophylaxis for spontaneous bacterial peritonitis in cirrhosis. Am J Gastroenterol 1998 93 1895-1900. 

Hepatic cirrhosis may be associated with portal hypertension, ascites, encephalopathy, spontaneous bacterial peritonitis, and hepatocellular carcinoma. Portal hypertension is directly responsible for the formation of esophageal varices, which may give rise to massive upper gastrointestinal bleeding. Therapy is aimed at correcting hypovolemic shock and at achieving hemostasis at the bleeding site. 

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