Naslov
Spontaneous Bacterial Peritonitis

Autori
Premuzić, Tihana Ann

Vrsta, podvrsta i kategorija rada
Ocjenski radovi, diplomski rad, diplomski

Fakultet
University of Zagreb Medical Studies in English

Mjesto
Zagreb

Datum
16.09

Godina
2013

Stranica
33

Mentor
Degoricija, Vesna

Ključne riječi
emergency; spontaneous; infection; advanced liver cirrhosis; bacterial translocation; diagnostic paracentesis; antibiotics

Sažetak
Spontaneous bacterial peritonitis is a serious infection of the ascitic fluid and an emergency situation found in patients with advanced liver cirrhosis who are without a secondary source for the infection such as a perforated viscus or abscess, carrying a mortality rate as high as 30- 40%. Although the pathogenesis for SBP has not been completely elucidated, the general mechanism for the infectious complication includes bacterial overgrowth and translocation from the intestinal lumen to the general circulation, as well as immunological compromise secondary to impairment of the reticuloendothelial system and defective bactericidal activity of ascitic fluid. Moreover a systemic inflammatory response is triggered with the production of vasodilatory mediators permitting changes in intestinal permeability, jeopardizing the intestinal mucosal barrier and thus further increasing bacterial translocation. Gut motility alterations also add to the bacterial translocation issue. With the production of vasodilatory mediators a counter-reaction is triggered. The sympathetic nervous system and renin-angiotensin-aldosterone system are activated and vasopressin is secreted, but eventually they only exacerbate the situation, producing a hyperdynamic circulation, contributing to massive fluid retention and culminating in end-organ injury. The diagnosis of SBP requires a high index of suspicion as it many times presents with subacute symptoms. Some centers institute a policy of paracentesis for every patient with liver cirrhosis and ascites, but certainly all agree diagnostic paracentesis is necessary in those who present with symptoms of infection, be they subacute or fulminant. Certain diagnosis is reflected in a polymorphonuclear leukocyte count of >250 cells/ml and/or positive culture of bacterial species from ascitic fluid. The treatment of SBP requires immediate intravenous antibiotics, a third-generation cephalosporin being the favored drug.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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