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Ascites and Spontaneous Bacterial Peritonitis

Ascites and Spontaneous Bacterial Peritonitis. Arthur Harris, MD Attending, Division of Gastroenterology Jacobi Medical Center/North Central Bronx Hospital Assistant Professor of Medicine, AECOM. Latest Physiopathology. Increased resistance to hepatic flow Portal hypertension

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Ascites and Spontaneous Bacterial Peritonitis

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  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

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

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

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

  5. Therapy It’s all about the sodium

  6. Spontaneous Bacterial Peritonitis

  7. 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

  8. 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

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