Spontaneous bacterial peritonitis laboratory findings: Difference between revisions

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* [[Urine culture]] to rule out [[asymptomatic bacteriuria]]  
* [[Urine culture]] to rule out [[asymptomatic bacteriuria]]  
===Ascitic Fluid Analysis===
===Ascitic Fluid Analysis===
* Absoulte neutrophil count - a total count of >250 cells/mm<sup>3</sup> along with positive cultures confirm the diagnosis of spontaneous bacterial peritonitis.
* Absoulte neutrophil count - a total count of >250 cells/mm<sup>3</sup> confirm the diagnosis of spontaneous bacterial peritonitis.
* When culture is positive, the most common organisms are Gram-negative bacteria (mainly ''[[Escherichia coli]]'') and Gram-positive cocci (usually [[Streptococcus]] spp. and [[enterococci]]).<ref name="pmid8228129">{{cite journal| author=Caly WR, Strauss E| title=A prospective study of bacterial infections in patients with cirrhosis. | journal=J Hepatol | year= 1993 | volume= 18 | issue= 3 | pages= 353-8 | pmid=8228129 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8228129  }} </ref>
* Some patients may have an ascitic neutrophil count <250 cells/mm<sup>3</sup> with positive cultures. This is known as "bacterascites''. This patients should undergo a second [[[paracentesis]]. Patients with signs of [[Systemic inflammatory response syndrome]] ([[SIRS]]) or in whom the repeat ascitic neutrophil count is >250 cells/mm<sup>3</sup> should receive antibiotic therapy, if not, the should be followed up.<ref name="pmid8228129">{{cite journal| author=Caly WR, Strauss E| title=A prospective study of bacterial infections in patients with cirrhosis. | journal=J Hepatol | year= 1993 | volume= 18 | issue= 3 | pages= 353-8 | pmid=8228129 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?
* Albumin concentration - it is important for the calculation of [[serum-ascites albumin gradient]] , this helps us in identifying the [[portal hypertension]] and prognosis.
* Albumin concentration - it is important for the calculation of [[serum-ascites albumin gradient]] , this helps us in identifying the [[portal hypertension]] and prognosis.
* Protein concentration - [[low protein concentration]] is noticed in cases of [[spontaneous bacterial peritonitis]] which differentiates it from secondary bacterial peritonitis where it is normal.
* Protein concentration - [[low protein concentration]] is noticed in cases of [[spontaneous bacterial peritonitis]] which differentiates it from secondary bacterial peritonitis where it is normal.
* When culture is positive, the most common organisms are Gram-negative bacteria (mainly ''[[Escherichia coli]]'') and Gram-positive cocci (usually [[Streptococcus]] spp. and [[enterococci]]).<ref name="pmid8228129">{{cite journal| author=Caly WR, Strauss E| title=A prospective study of bacterial infections in patients with cirrhosis. | journal=J Hepatol | year= 1993 | volume= 18 | issue= 3 | pages= 353-8 | pmid=8228129 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8228129  }} </ref>


==References==
==References==

Revision as of 14:57, 16 June 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Guillermo Rodriguez Nava, M.D. [3]

Overview

Diagnosis requires paracentesis (needle drainage of the ascitic fluid). Ascites culture is negative in up to 60% of patients with clinical manifestations of spontaneous bacterial peritonitis (SBP), therefore, the diagnosis is based on the neutrophil count, which reaches its highest sensitivity with a cutoff neutrophil count of > 250/mm3.[1]

Laboratory Findings

Laboratory tests, most importantly ascitic fluid analysis is required for confirmation of diagnosis of spontaneous bacterial peritonitis.

Ascitic Fluid Analysis

  • Absoulte neutrophil count - a total count of >250 cells/mm3 confirm the diagnosis of spontaneous bacterial peritonitis.
  • When culture is positive, the most common organisms are Gram-negative bacteria (mainly Escherichia coli) and Gram-positive cocci (usually Streptococcus spp. and enterococci).[2]
  • Some patients may have an ascitic neutrophil count <250 cells/mm3 with positive cultures. This is known as "bacterascites. This patients should undergo a second [[[paracentesis]]. Patients with signs of Systemic inflammatory response syndrome (SIRS) or in whom the repeat ascitic neutrophil count is >250 cells/mm3 should receive antibiotic therapy, if not, the should be followed up.<ref name="pmid8228129">{{cite journal| author=Caly WR, Strauss E| title=A prospective study of bacterial infections in patients with cirrhosis. | journal=J Hepatol | year= 1993 | volume= 18 | issue= 3 | pages= 353-8 | pmid=8228129 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?
  • Albumin concentration - it is important for the calculation of serum-ascites albumin gradient , this helps us in identifying the portal hypertension and prognosis.
  • Protein concentration - low protein concentration is noticed in cases of spontaneous bacterial peritonitis which differentiates it from secondary bacterial peritonitis where it is normal.

References

  1. European Association for the Study of the Liver (2010). "EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis". J Hepatol. 53 (3): 397–417. doi:10.1016/j.jhep.2010.05.004. PMID 20633946.
  2. Caly WR, Strauss E (1993). "A prospective study of bacterial infections in patients with cirrhosis". J Hepatol. 18 (3): 353–8. PMID 8228129.


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