spontaneous bacterial peritonitis.pptx
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Spontaneous bacterial peritonitis is a common infection in patients with cirrhosis caused by bacteria translocating from the intestine into the ascitic fluid through the lymphatic system or bloodstream. It is diagnosed when ascitic fluid shows a neutrophil count over 250 cells/uL and culture grows bacteria. Treatment involves early administration of broad-spectrum antibiotics like cefotaxime for 5 days. Adjuvant therapies with albumin and discontinuing beta-blockers may improve outcomes in patients with renal dysfunction or jaundice. Long-term antibiotic prophylaxis can prevent recurrent infections.
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Spontaneous Bacterial Peritonitis (SBP)
Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid in people with liver cirrhosis and ascites. It is defined by a positive ascitic fluid culture with ≥250 PMN cells/mm3 in the absence of an intra-abdominal source. Risk factors include low ascitic fluid protein and prior SBP. Translocation of gut bacteria through the intestinal wall and lymphatics is a main mechanism. Treatment involves antibiotics like cefotaxime for 5-7 days. Prognosis depends on clinical stability, though prophylaxis may be considered for high risk patients.
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2. Upper GI bleeding occurs above the ligament of Treitz and can cause hematemesis or melena, while lower GI bleeding occurs below and causes melena and hematochezia but no hematemesis.
3. Common causes of upper GI bleeding include peptic ulcer disease, gastritis, and esophageal varices, while common causes of lower GI bleeding include hemorrhoids, diverticulosis, and polyps.
Upper GI Bleeding
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Sbp
This document provides an overview of spontaneous bacterial peritonitis (SBP), including definitions, classifications, etiology, pathophysiology, clinical features, investigations, treatment, prognosis, and prevention. SBP is defined as an infection of initially sterile ascitic fluid without an identifiable source. It is commonly seen in patients with cirrhosis and ascites. Diagnosis involves ascitic fluid analysis showing positive culture or elevated PMN count. Treatment involves early empirical antibiotics and albumin supplementation improves outcomes. Prognosis depends on severity of underlying liver disease. Primary prophylaxis can delay complications and improve survival.
Spontaneous Bacterial peritonitis
1) Spontaneous bacterial peritonitis (SBP) is an infection of the ascitic fluid without an evident intra-abdominal surgically treatable cause.
2) Abdominal paracentesis should be performed for patients with ascites who present with signs of infection like fever or abdominal pain. The ascitic fluid is examined for white blood cell count and cultured.
3) SBP is diagnosed if the ascitic fluid white blood cell count is above 250 cells/mm3 or has a positive culture. Treatment involves antibiotics like cefotaxime for 5 days along with intravenous albumin to prevent kidney injury.
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This document provides information about renal tuberculosis, including its diagnosis and management. It begins with a brief history of tuberculosis and then focuses on renal tuberculosis. Key points include:
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- Diagnosis involves urine analysis showing pyuria and sterile cultures, imaging like intravenous pyelography showing calcifications and abnormalities, and culture of urine or tissues.
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Spontaneous Bacterial Peritonitis (SBP)
Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid in people with liver cirrhosis and ascites. It is defined by a positive ascitic fluid culture with ≥250 PMN cells/mm3 in the absence of an intra-abdominal source. Risk factors include low ascitic fluid protein and prior SBP. Translocation of gut bacteria through the intestinal wall and lymphatics is a main mechanism. Treatment involves antibiotics like cefotaxime for 5-7 days. Prognosis depends on clinical stability, though prophylaxis may be considered for high risk patients.
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2. Upper GI bleeding occurs above the ligament of Treitz and can cause hematemesis or melena, while lower GI bleeding occurs below and causes melena and hematochezia but no hematemesis.
3. Common causes of upper GI bleeding include peptic ulcer disease, gastritis, and esophageal varices, while common causes of lower GI bleeding include hemorrhoids, diverticulosis, and polyps.
Upper GI Bleeding
Upper GI bleeding is a common cause of hospitalization. The most common cause is peptic ulcer disease, which is strongly associated with H. pylori infection. Mortality is 6-10% overall and is usually due to comorbidities rather than bleeding itself. Treatment involves resuscitation, endoscopy, and treating the underlying cause. Endoscopy allows for identification and treatment of the bleeding site. Long term prevention involves treating H. pylori infection, avoiding NSAIDs when possible, and using PPIs for gastroprotection.
Sbp
This document provides an overview of spontaneous bacterial peritonitis (SBP), including definitions, classifications, etiology, pathophysiology, clinical features, investigations, treatment, prognosis, and prevention. SBP is defined as an infection of initially sterile ascitic fluid without an identifiable source. It is commonly seen in patients with cirrhosis and ascites. Diagnosis involves ascitic fluid analysis showing positive culture or elevated PMN count. Treatment involves early empirical antibiotics and albumin supplementation improves outcomes. Prognosis depends on severity of underlying liver disease. Primary prophylaxis can delay complications and improve survival.
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1) Spontaneous bacterial peritonitis (SBP) is an infection of the ascitic fluid without an evident intra-abdominal surgically treatable cause.
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- Diagnosis involves urine analysis showing pyuria and sterile cultures, imaging like intravenous pyelography showing calcifications and abnormalities, and culture of urine or tissues.
- Radiological findings include calcifications, cavitary lesions, infundibular strictures, and evidence of destruction like a "putty kidney". Management involves antibiotic therapy but can be complicated
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Acute calculous cholecystitis is caused by obstruction of the cystic duct by a gallstone. Symptoms include biliary colic, fever, and right upper quadrant pain. Ultrasound and hepatobiliary scintigraphy can diagnose thickened gallbladder walls and obstruction. Treatment involves early laparoscopic cholecystectomy for mild cases, or initial conservative treatment with antibiotics and potential percutaneous cholecystostomy for severe cases presenting with sepsis, with delayed cholecystectomy once the patient improves. Guidelines recommend early surgery for mild disease and initial medical management for severe acute cholecystitis.
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This document discusses lower gastrointestinal (GI) bleeding, including its causes, presentation, evaluation, and management. Some key points:
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2. Symptoms include fever over 102°F, flank pain, painful or frequent urination, and other urinary symptoms. Risk factors include female anatomy, kidney stones, diabetes, and other underlying conditions.
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Peritonitis is inflammation of the peritoneum lining the abdominal cavity. There are several types depending on cause, including primary, secondary, and tertiary peritonitis. Primary peritonitis includes spontaneous bacterial peritonitis which occurs in those with cirrhosis and ascites. Secondary peritonitis results from infection spreading from a ruptured organ. Tertiary peritonitis is persistent or recurrent infection after source control of secondary peritonitis. Diagnosis involves ascitic fluid analysis and treatment involves antibiotics.
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This document defines pyelonephritis as inflammation of the kidney parenchyma and renal pelvis lining. It discusses the epidemiology and risk factors, including those related to host factors like sex, obstruction, and genetics. The etiology is typically gram-negative bacteria like E. coli ascending from the urethra. Clinical features range from mild fever to severe fever and flank pain. Diagnosis involves urine testing and culture. Treatment depends on severity and involves antibiotics like fluoroquinolones for 7-14 days.
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- Occult LGI bleeding is first evaluated with fecal occult blood testing (FOBT). CT angiography can help localize bleeding if it persists or patients are unstable.
- Evaluation involves history, physical exam including rectal exam, blood tests, stool tests, endoscopy, imaging studies like colonoscopy, angiography or nuclear scans depending on findings.
- Treatment depends on
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2. Symptoms include fever over 102°F, flank pain, painful or frequent urination, and other urinary symptoms. Risk factors include female anatomy, kidney stones, diabetes, and other underlying conditions.
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Febrile neutropaenia
1. Febrile neutropenia is a serious complication of cancer chemotherapy defined as a fever and low white blood cell count. It occurs in around 8 in 1000 chemotherapy patients and carries risks of complications and 10% mortality.
2. Risk of febrile neutropenia depends on chemotherapy regimen and individual risk factors. It is managed initially with broad-spectrum antibiotics and daily monitoring until fever and white blood cell count recovery. Additional treatments may be needed if fever persists.
3. Gram-positive and Gram-negative bacteria are common causes but resistant strains are increasing. Fungal and viral infections must also be considered depending on patient risk and response to initial antibiotics.
MANAGEMENT OF INFECTIONS IN
1) Hospital-acquired infections are a major cause of increased morbidity, mortality and costs in hospitals, with the neurological ICU having one of the highest rates of infections due to factors like impaired sensorium and devices.
2) Common pathogens causing infections include Escherichia coli, Klebsiella, Pseudomonas aeruginosa and Acinetobacter, with urinary tract infections being the most frequent type.
3) Preventive measures include using the smallest necessary urinary catheter, maintaining a closed drainage system, and not routinely changing catheters or using antibiotics for prevention.
Abdominal Sepsis and Peritonitis
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Sepsis protocol 2016 : Notes2021
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- 1. Dr Ishatir Radiyate Ranu Intern Doctor Medicine unit:7 Dhaka Medical College And Hospital
- 2. Spontaneous bacterial peritonitis is defined as an ascitic fluid infection without an evident intra- abdominal surgically treatable source. SBP is the most common bacterial infection in patients with cirrhosis – results from translocation of bacteria from intestine into ascitic fluid.
- 3. 1)Translocation: Gut bacteria traverse the intestinal wall and colonize in mesenteric lymph nodes. 2) Bacterascites can occur if the lymphatic carrying the contaminated lymph ruptures – due to high flow and high pressure associated with portal hypertension.
- 4. 3) Alternatively, mesenteric lymphatics ->systemic circulation -> percolate through the liver -> weep across Glisson’s capsule to enter the ascetic fluid. 4) Hematogenous :bacteria causing SBP can also originate in sites other than the gut via bacteremic seeding.
- 5. Most cases of SBP are due to gut bacteria such as Escherichia coli and Klebsiella, though Streptococcal and Staphylococcal infections can also occur. As a result ,broad-spectrum therapy is warranted until the results of susceptibility testing are available.
- 6. • Advanced cirrhosis • paracentasis • GI bleeding • Proton pump inhibitor (decrese phagocyte oxidative burst) • UTIs • Deficient ascetic fluid bactericidal activity – AF c3 level <13mg/dl or AF total protein <1gm/dl
- 7. • Serum total bilirubin concentration above 2.5 mg/dl • Previous episode of SBP
- 8. • Abdominal pain or fever in a patient with obvious features of cirrhosis and ascites. However ,abdominal signs are mild or absent in about one-third of patients. • Hepatic encephalopathy • Non specific deteriorations • Associated with a high rate of acute kidney injury and mortality.
- 9. • Clinical features • Diagnostic paracentesis: 1)may show cloudy fluid, 2) ascites neutrophil count >250*10^6 /L almost invariably indicates infection, 3) positive ascitic culture.
- 10. Start as early as possible Indication of starting emprirical antibiotic therapy: Fever >100.4F Abdominal pain or tenderness Altered mental status
- 11. Prefarably a third generation cephalosporins intravenously: i. Cefotaxime 2 gm 8 hourly ii. Ceftriaxone 2gm/day when cefotaxime is not available. iii. In case of resistance to third generation cephalosporins, piperacillin-tazobactam or carbapenems are the antibiotic of choice.
- 12. • Usually a 5 days antibiotic regimen is practiced • Treating until 48 hours after the signs and symptoms have disappeared is also effective. • Longer treatment is considerd in: Unusal organisms like Pseudomonas Resistant organisms Organisms associated with endocarditis (eg. Staph aureus or Viridans streptococcus)
- 13. • Discontinue non selective beta blockers: among pt with SBP ,beta blocker use is associated with worse outcomes compared with those not receiving beta blocker. • Albumin administration for patients with jaundice or renal dysfunction: renal failure develops in 30 to 40 percent of patients with SBP and is a major cause of death.
- 14. Renal impairement is to be treated with intravenous infusion of 25% albumin solution,administered within 6 hrs of diagnosis – 1.5gm/kg body weight on 1st day and 1gm/kg body weight on 3rd day (maximum dose 100g) Once renal failure has developed, treating with octreotide and midodrine may be helpful.
- 15. Patient with bacterascites: in some patients, infection is detected at the bacterascites stage ie. Bacteria are present in the ascetic fluid, but the PMN count is <250cells/microL. i. In symptomatic patient – start treatment ii. If patient is asymptomatic, repeat paracentesis after 48 hrs and treatment is initiated if the PMN count has risen to >250cells/microL.
- 16. Secondary bacterial peritonitis and polymicrobial infections: should consider broader coverage with cefotaxime and metronidazole and surgical intervention in secondary peritonitis is a must. Culture-negative neutrocytic ascites: pt with an ascetic fluid PMN count >250cells/microL but have negative ascetic fluid culture. As most of such patients have SBP,they should be treated with empirical antibiotic.
- 17. o To prevent recurrent SBP o Choice of antibiotic: Norfloxacin 400mg/day or ciprofloxacin 750mg/week or cotrimoxazole 960mg/day o Primry antibiotic prophylaxis also reduces the incidence of SBP in patients with low ascetic protein <15g/L
- 18. All admitted patient should undergo diagnostic paracentesis unless contraindicated. Try to rule out secondary causes in all possible cases Early antibiotic therapy grossly alters the final outcome Primary prophylaxis has a role in preventing systemic complications and improving survival.
- 19. Thank You
- 20. Davidson’s Principles And Practice of Medicine, 24th edition American Association For The Study Of Liver Diseases (AASLD) Guideline, 2021