Definitions

A number of definitions are needed to simplify the understanding and presentation of these complex relationships. Prevalence is loosely defined in the Random House Dictionary of the English Language as the extent of occurrence of an event, disease, symptom, sign, cost or other characteristic. It is not limited to a specific unit of time, but it may be restricted to a specific country or type of disease, e.g., alcoholic cirrhosis. Incidence is more rigorously defined as the rate of occurrence of...

References

Spontaneous peritonitis and bacteremia in cirrhotic patients caused by enteric bacteria. Ann Intern Med 60 568-580, 1964. 2. Conn HO, Fessel JM. Spontaneous bacterial peritonitis in cirrhosis. Variations on a theme. Medicine 50 161-197, 1971. 3. Correia JP, Conn HO. Spontaneous bacterial peritonitis in cirrhosis Endemic or epidemic Med Clin North Am 59 963-981, 1975. 4. Goldfarb J, Conn HO. Spontaneous bacterial peritonitis Endemic epidemic. In Hepatic Biliary and Pancreatic Surgery,...

Bpip

Reduces rate of BT Reduces mortality Reduces colony count Enhances bacterial killing Improves mucosal barrier function Improves survival Increases bacterial killing Enhances bacterial killing Decreases BT Decreases BT Inhibits endotoxin and his associates studied the effects of an arginine-supplemented diet (11) because arginine has been shown to have beneficial immunomodulating activity in infected animals (12). In their endotoxin-induced BT model in mice, they demonstrated that arginine (2...

Different Types Of Cirrhosis With

This pattern of4 'variations on a theme'' has continued, virtually every possible variable has been documented, and thus the syndrome has been broadened considerably. All of the first 29 patients, for example, had micronodular alcoholic cirrhosis. It was not difficult to predict that other types of cirrhosis would also be associated with SBP. These variations, some of which were observed in our series, but most of which have been reported by other investigators elsewhere, will be documented...

Noncirrhotic SBP

SBP has also occurred in patients with ascites of noncirrhotic origin such as neoplastic ascites (49), i.e., the ascites that develops in patients with portal hypertension following metastases to the liver and or the peritoneum. Actually one can sense that these are pathogenetically two very different phenomena. Metastases to the peritoneum tend to cause a syndrome characterized by blood and neoplastic cells in the ascitic fluid. On the other hand, intrahepatic metastases tend to cause ascites...

Rationale For Primary Prophylaxis Of Spontaneous Bacterial Peritonitis

Spontaneous bacterial peritonitis (SBP) is a frequent complication in cirrhotic patients with an incidence ranging between 8 and 27 during a single hospitalization (1-3). Considering patients with ascites and without previous SBP, the one-year probability of developing the first episode of SBP is 11 -29 (4,5). These figures increase to 20-50 when considering high-risk groups defined by low ascitic fluid total protein (< 10 g L) or high serum bilirubin levels (> 2.5 mg dL) (4,5). Moreover,...

Historical Vignette

It is of historical interest that Ludwig von Beethoven is probably the first patient known by name to have had SBP, especially since the clinical description of his case had been written 135 years before this syndrome was first described. Ever since I became aware of Beethoven's illness, it has seemed to me that SBP is the most likely explanation for his symptoms. It is even more astounding that this disease occurred in such an illustrious person. If he had not been so famous, his case history...

What Are The Possible Routes By Which Bacteria May Enter The Peritoneum

Organisms can come directly from the gastrointestinal tract, from the blood stream, from the lymphatics or, in females, from the genital tract. The rarest route is through the Fallopian tubes. . . . This route of entry has been implicated by McCartney to explain the predominance of girls with primary peritonitis (5). Obviously, this mechanism played no role in any of our patients, all of whom were male. It is conceivable that this route could have been responsible for some of the women...

Phospholipids in Prevention of BT

Wang and associates have shown that BT after hepatectomy in Sprague-Dawley rats can be decreased by the administration of phospholipids (phosphoti- dylcholine and phosphotidylinositol) (52). Presumably, these effects are mediated by maintaining the integrity of the intestinal barrier. Wang et al. have also shown that ethylhydroxyethyl cellulose prevents the BT induced by large hepatic resections (90 ) in rats (53). Although the mechanism of this effect is not known, it might be caused by the...

Shortterm Prophylaxis Of Bacterial Infections In Hospitalized Cirrhotic Patients

Several studies have demonstrated that short-term prophylactic antibiotic therapy during hospitalization dramatically reduces the incidence of nosocomial bacterial infections in cirrhotic patients admitted with gastrointestinal bleeding or with ascites with a low ascitic fluid total protein concentration. A. Cirrhotic Patients with Gastrointestinal Bleeding In 1985, Rimola et al. (28) published the first study on antibiotic prophylaxis of bacterial infections in cirrhotic patients. This...

Fibrous Encapsulating Peritonitis The Cocoon Syndrome

In their description of a most unusual case of SBP in a noncirrhotic patient, Leport et al. described a patient who, in the absence of any history of preceding liver disease, developed pneumococcal bacteremia, but whose ascitic fluid was sterile (42). The patient, a 36-year-old Moroccan woman, who had had no history of alcohol ingestion, abdominal disease, or surgery, developed fever, abdominal pain, and diarrhea. She had given birth to nine children uneventfully. On physical examination she...

Other Iatrogenic Types of SBP

Iatrogenic is defined as induced by a physician or by the physician's actions. Iatrogenic SBP can therefore be defined as an episode of SBP induced by a healthcare worker during or as a consequence of a diagnostic or therapeutic procedure. Physicians, surgeons, dentists, nurses, or their colleagues are all capable (and culpable) of inducing SBP in cirrhotic patients. A physician's failure to incise an abscess may induce SBP as an act of omission whereas the bacteremia following such an incision...

Laboratory Variations In

Culture-Negative SBP (CNSBP) and Culture-Negative Neutrocytic Ascites (CNNA) CNSBP is defined as the presence of the clinical picture of SBP, ascites that contains more than 250 polymorphonuclear leukocytes (PMNs) per cubic millimeter, a sterile ascitic fluid culture, and no explanation for the abdominal finding (50). In the most simple sense it represents culture-negative SBP. How can such a syndrome develop What does it signify First, it may represent SBP at an early phase in its course,...

Chronic Ambulatory Peritoneal Dialysis CAPD

CAPD may be considered either a common variant of SBP or a completely separate syndrome with many features in common (57). Although I consider it to be the latter, it is appropriate to discuss it in detail here. Infection of the peritoneal cavity by bacteria is the major complication of CAPD (55,56). SBP is a bacterial infection of a pre-existing pathophysiological accumulation of peritoneal fluid, a pathophysiological consequence of portal hypertension that develops almost exclusively in...

Multiplicity of Infecting Species

More than 70 species of bacteria have been isolated from the AF of patients with bacteriologically proved SBP Table 3.4 . The infecting bacteria are predominantly species indigent to the human gastrointestinal tract. They are usually aerobic, gram-negative rods, but coccal forms of all types may be present. They have been arbitrarily divided into a aerobic, gram-negative bacilli, b cocci, both gram-negative and gram-positive, c anaerobic bacteria, d inherently pathogenic bacteria, and e...