In peritonitis, spontaneous bacterial

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... 

Peritonitis may be classified as primary, secondary, or tertiary. Primary peritonitis, also called spontaneous bacterial peritonitis, is an infection of the peritoneal cavity without an evident source of bacteria from the abdomen.1,2 In secondary peritonitis, a focal disease process is evident within the abdomen. Secondary peritonitis may involve perforation of the gastrointestinal (GI) tract (possibly because of ulceration, ischemia, or obstruction), postoperative peritonitis, or posttraumatic peritonitis (e.g., blunt or penetrating trauma). Tertiary peritonitis occurs in critically ill patients and is infection that persists or recurs at least 48 hours after apparently adequate management of primary or secondary peritonitis. 

Chang CS, Chen GH, Lien HC, Yeh HZ Small intestine dysmotility and bacterial overgrowth in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology 1998 28 1187-1190. 

Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhotic ascites, arising most frequently in those with advanced liver disease. Its development leads to a further reduction in the effective arterial blood volume, and it has a mortality rate equivalent to that of a variceal bleed [202], Since hepatic blood flow and func-... 

Soares-Weiser K, Brezis M, Leibovici L Antibiotics for spontaneous bacterial peritonitis in cirrhotics. Cochrane Database Syst Rev 2001 3 CD002232. 

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. 

Guarner C, Runyon BA, Heck M, Young S, Sheikh MY Effect of long-term trimetho-prim/sulfamethoxazole prophylaxis on ascites formation, bacterial translocation, spontaneous bacterial peritonitis and survival in cirrhotic rats. Dig Dis Sci 1999 44 1957— 1962. 

Trespi E, Colla C, Belloni G, Pollino MG, Magnani L, Panizza P, Venturini A Efficacy of rifaximin as a prophylactic agent for the prevention of spontaneous bacterial peritonitis in alcoholic patients. Ital J Gastroenterol Hepatol 1999 31 534A. 

Gines P, Arroyo V, Rhodes J. Ascites, hepatorenal syndrome, and spontaneous bacterial peritonitis. In MacDonald JWD, Burroughs AK, Feagan BG, editors. Evidence-based gastroenterology and hepatology. 2nd ed. London Blackwells Publishing, BMJ Books 2004. p. 487-503. 

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. 

Transplantation of the liver essentially gives patients with refractory portal ascites a chance to start a new life. However, in the presence of large-scale ascites, the surgeon is faced with a number of specific problems such as overdilated and thin abdominal walls, existing hernia, spontaneous bacterial peritonitis, significant volume displace-... 

Akriviadis, A., Runyon, B.A. Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology 1990 98 127-133... 

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

L., Fraquelli, M., Penagini, R., Biandii, P.A. Erequency of spontaneous bacterial peritonitis in 265 cirrhotics with ascites. Europ. X Gastroenterol. Hepatol. 1993 5 41-45... 

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... 

Evans, L.T., Kim, W.R., Poterucha, J.J., Kamath, P.S. Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites. Hepatology 2003 37 897-901... 

Gitlin, N., Stauffer, J.L., Silvestri, R.C. The pH of ascitic fluid in the diagnosis of spontaneous bacterial peritonitis in alcoholic patients. Hepatology 1992 2 406-411... 

---