Ascites are excess accumulation of fluid in abdominal cavity

1. Ascites and Spontaneous
Bacterial Peritonitis
Arthur Harris, MD
Attending, Division of Gastroenterology
Jacobi Medical Center/North Central Bronx Hospital
Assistant Professor of Medicine, AECOM

5. Latest Physiopathology
• Increased resistance to hepatic flow
• Portal hypertension
• Production of splanchnic arterial
vasodilators (NO)
• Early cirrhosis
• Late cirrhosis

6. Consequences of vasodilatation
• Decreased effective plasma
volume
• Sodium retention
• Increased capillary permeability

8. Ascites – Patient Evaluation
• Assess liver function
• Evaluation of renal and CVS function
• Ascitic fluid analysis
• Endoscopy for varices

12. Therapy
It’s all about the sodium

17. Spontaneous Bacterial Peritonitis

23. SBP – Antibiotic Therapy I
• Initiate for PMN≥250/mm3
• IV Cefotaxime 2g q8 hours or
Ceftriaxone 2g q24hours
• Duration of therapy unclear
–2 weeks suggested if Blood cultures(+)
–If repeat paracentesis at 48 hours shows
PMN≤250/mm3, then 5-7 days of
treatment may be adequate

25. SBP – Antibiotic Therapy II
• Prophylactic antibiotics should also be
prescribed indefinitely until ascites
has eliminated
• Options include:
-Bactrim DS 1 tab po 5 days/week
-Cipro 750mg po q week