Gastro: Spontaneous Bacterial Peritonitis: Free MSRA Podcast

🎧 FREE MSRA PODCAST – Spontaneous Bacterial Peritonitis(SBP): Recognise, React, ReviseIn this high-yieldMSRA podcast episode, we unpack SpontaneousBacterial Peritonitis (SBP) — a seriousinfection that often complicates cirrhosiswith ascites. Learn how to spot it early, investigate it properly, andtreat it promptly to save lives. Fast facts, mnemonics, and NICE-based tipsthroughout. 🧠 Key Learning Points 📌 Definition• SBP is an infection of ascitic fluid without a surgicallytreatable source (e.g. no perforation or abscess).• Occurs almostexclusively in patients with cirrhosis andascites.• Most commonpathogens: E. coli, Klebsiella pneumoniae(gram-negative enteric organisms). 📌 Pathophysiology• Caused by bacterial translocation from the gut through a leaky intestinal wall, combined with poor immune defences in cirrhosis.• Ascitic fluid with low protein (<15 g/L)lacks opsonic activity, making it easier for bacteria to establish infection. 📌 Mnemonics to Remember• LLAGP – Risk Factors: – L: Liver cirrhosis – L: Low ascitic protein – A: Ascites – G: GI bleeding – P: Previous SBP episode• FAT WAS – Key Symptoms/Signs: – Fever – Abdominal pain – Tenderness – Worsening ascites – Altered mental status – Systemic infection signs 📌 Diagnosis• Diagnostic paracentesis (ascitic tap) is essential.• PMN count ≥ 250 cells/mm³ in ascitic fluid =diagnostic.• Send for culture, Gramstain, and assess for albumin, LDH, glucose.• Blood tests (WCC,CRP, LFTs) for systemic involvement.• Imaging (e.g. CT)to rule out secondary peritonitis (e.g.perforated viscus). 📌 Treatment• Empirical IV antibiotics immediately –typically: – Cefotaxime (3rd generation cephalosporin) or asper local guidelines• Stop diureticstemporarily.• Albumin infusion(1.5 g/kg on Day 1, 1 g/kg on Day 3) in high-risk patients may reduce risk ofrenal failure. 📌 Prophylaxis• Indicated in high-risk patients: – Ascitic fluidprotein <15 g/L – Child-Pugh score≥9 – Hepatorenalsyndrome – Previous SBPepisode• Prophylactic oralantibiotics: – Norfloxacin, ciprofloxacin,or co-trimoxazole as per local policy• Continueprophylaxis until ascites resolves or long term if liver disease is ongoing. 📌 Prognosis & Complications• Can rapidly leadto: – Sepsis – Hepatorenal syndrome – Multi-organ failure• In-hospital mortality is high (up to 30%) — early diagnosisis key• Recurrence is common – hence, lifelong prophylaxis may be needed 📌 Summary Recap• SBP = infection in ascitic fluid with no surgicalcause• Risk factors: LLAGP• Red flags: FAT WAS• Diagnosis: Ascitic neutrophils ≥ 250/mm³• Treatment: IV antibiotics (e.g. cefotaxime) + albumin in somecases• Preventrecurrence: prophylactic antibiotics forhigh-risk groups• Always rule out secondary peritonitis 📎 More MSRA Resources for Spontaneous Bacterial Peritonitis📝 Revision Notes:https://www.passthemsra.com/topic/spontaneous-bacterial-peritonitis-revision-notes/🧠 Flashcards:https://www.passthemsra.com/topic/spontaneous-bacterial-peritonitis-flashcards/💬 Accordion Q&A Notes:https://www.passthemsra.com/topic/spontaneous-bacterial-peritonitis-accordion-qa-notes/🚀 Rapid Quiz:https://www.passthemsra.com/topic/spontaneous-bacterial-peritonitis-rapid-quiz/🎓 Full Course:https://www.passthemsra.com/courses/gastroenterology-for-the-msra/ Hashtags#MSRA#MSRARevisionNotes #SpontaneousBacterialPeritonitis #MSRAFlashcards #GastroMSRA#AsciticTap #SBPTreatment #LiverCirrhosis #Cefotaxime #HepatorenalSyndrome#MSRAQuiz #MSRAAccordions