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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Spontaneous bacterial peritonitis (SBP) is one of the most common and life-threatening complications of cirrhosis. It occurs in 10% to 30% of patients admitted to hospital and recent studies tend to demonstrate that SBP incidence seems to be decreasing in its frequency. A bacterial overgrowth with translocation through the increased permeable small intestinal wall and impaired defense mechanisms is considered to be the main mechanism associated with its occurrence. The Gram-negative aerobic bacteria are the major responsible for SBP episodes and Gram-positive bacteria, mainly Staphylococcus aureus, are being considered an emergent agent causing SBP. The prompt diagnosis of SBP is the key factor for reduction observed in mortality rates in recent years. The clinical diagnosis of SBP is neither sensitive nor specific and the search for new practical and available tools for a rapid diagnosis of SBP is an important endpoint of current studies. Reagent strips were considered a promising and faster way of SBP diagnosis. The prompt use of empirical antibiotics, mostly cefotaxime, improves significantly the short-term prognosis of cirrhotic patients with SBP. The recurrence rate of SBP is high and antibiotic prophylaxis has been recommended in high-risk settings. Unfortunately, the long-term prognosis remains poor.
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PMID:Spontaneous bacterial peritonitis: How to deal with this life-threatening cirrhosis complication? 1920 74

Spontaneous bacterial peritonitis (SBP), a common complication of cirrhosis of liver, might result from translocation of bacteria from the small bowel. However, there is scanty data on frequency of small intestinal bacterial overgrowth (SIBO) in patients with cirrhosis of the liver. There are no data on SIBO in patients with extra-hepatic portal venous obstruction (EHPVO) in the literature. A total of 174 patients with cirrhosis of the liver, 28 with EHPVO and 51 healthy controls were studied for SIBO using glucose hydrogen breath test (GHBT). Persistent rise in breath hydrogen 12 ppm above basal (at least two readings) was considered diagnostic of SIBO. Of 174 patients (age 47.2 +/- 11.9 years, 80.5% male) with cirrhosis due to various causes, 67 (38.5%) were in Child's class A, 70 (40.2%) class B and 37 (21.7%) class C. Of the 174 patients with cirrhosis, 42 (24.14%) had SIBO as compared to 1 of 51 (1.9%) healthy controls (P < 0.0001). Patients with EHPVO had similar frequency of SIBO compared to healthy controls [2/28 (7.14%) vs 1/51 (1.97%), P = ns]. Frequency of SIBO in Child's A, B and C was comparable [13 (18.6%) vs 16 (23.9%) and 13 (35.1%), respectively; P = ns]. Presence of SIBO were not related to ascites, etiology of cirrhosis, and degree of liver dysfunction. SIBO is common in patients with cirrhosis of the liver. Patients with EHPVO do not have higher frequency of SIBO than healthy subjects. SIBO in cirrhosis is not related to the degree of derangement in liver function or of portal hypertension.
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PMID:Frequency and factors associated with small intestinal bacterial overgrowth in patients with cirrhosis of the liver and extra hepatic portal venous obstruction. 1942 96

SUMMARY: Serum and ascitic fluid superoxide dismutase (SOD) and malondialdehyde (MDA) levels were measured in 43 patients with cirrhosis and in a 10 healthy control group. Compensated cirrhotic patients had no clinically detectable ascites, but decompensated patients had massive ascites. Cirrhotic patients were divided into three groups: patients with compensated cirrhosis (n = 16), patients with decompensated cirrhosis with Spontaneous bacterial peritonitis (SBP) (n = 14), and patients with decompensated cirrhosis without SBP (n = 13). All cirrhotic patients in the experimental group had significantly higher serum SOD (p < 0.001) and MDA levels (p < 0.01) than those in the control group. There were no significant differences with respect to serum SOD and MDA levels among the three different groups of patients. There was no remarkable difference in ascitic fluid SOD and MDA levels between decompensated cirrhotic patients with and without SBP (p > 0.05). These results suggest that the increase in serum SOD and MDA levels are not related to the presence of SBP and the status of liver cirrhosis. To sum up, clarifying the impact of increased serum SOD and MDA levels in cirrhotic patients needs further investigation.
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PMID:Serum and Ascitic Fluid Superoxide Dismutase and Malondialdehyde Levels in Patients with Cirrhosis. 1957 1

Spontaneous bacterial peritonitis (SBP) is a common cause of morbidity and mortality in patients with advanced cirrhosis and portal hypertension. While gram-negative rods and Enterococcus species are the common offending organisms, Salmonella has also been recognized as a rare and atypical offending organism. Atypical features of Salmonella SBP include both its occurrence in cirrhotic patients with immunosuppressive state and its lack of typical neutroascitic response. Diagnosis is often delayed as it requires confirmation from ascitic fluid culture. We report a case of Salmonella SBP occurring in a patient with decompensated cryptogenic cirrhosis with concurrent low-grade non-Hodgkin lymphoma and prior treatment with rituximab. Physicians should be aware of the atypical presentation, especially in cirrhotic patients who are immunosuppressed.
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PMID:Spontaneous bacterial peritonitis from Salmonella: an unusual bacterium with unusual presentation. 1966 70

Infections in patients with cirrhosis are a common complication causing substantial morbidity and mortality. Bacterial translocation plays an important role in the pathogenesis of many infections in cirrhosis. In turn, infections are involved in the pathogenesis of many episodes of decompensated cirrhosis, such as esophageal variceal bleeding, renal insufficiency, the hemodynamic alterations of cirrhosis, and hepatic encephalopathy. Spontaneous bacterial peritonitis is currently the most frequent infection in cirrhosis. Mortality from this entity has recently decreased due to early diagnosis, the use of appropriate antibiotic therapy, and albumin administration. However, infections due to multiresistant microorganisms have recently increased, leading to greater mortality. Primary prophylaxis with quinolones is effective in preventing infections and is associated with lower mortality in a selected population of patients with liver cirrhosis.
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PMID:[Current problems in the prevention and treatment of infections in patients with cirrhosis]. 2133 16

Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis and is defined as infected ascites in the absence of any recognizable secondary cause of infection. The aim of the study was to evaluate the prevalence, incidence, pathogens and clinical outcome of SBP. This prospective observational study included 108 cirrhotic patients with ascites treated during 18 months. Patients were divided into two groups according to diagnostic criteria of SBP: SBP group (n=23) and non-SBP group (n=85). Differences in clinical outcomes between the two groups were analyzed, including mortality rate, incidence of gastrointestinal bleeding, bacteremia/sepsis and frequency of rehospitalization. The pathogens responsible for SBP were analyzed in SBP group. The prevalence of SBP was 21% and incidence 14.1% per year. Statistically significant between-group differences were recorded in mortality (26% vs. 4.7%; P=0.017), incidence of gastrointestinal bleeding (39% vs. 11.7%; P=0.015) and rehospitalization frequency (47.8% vs. 20%; P=0.05). The incidence of sepsis following episode of gastrointestinal bleeding was similar in both groups (55.5% vs. 50%; P=0.892). The following pathogens were responsible for SBP: Escherichia coli (n=7), MRSA (n=2), Acinetobacter spp. (n=2), Staphylococcus aureus (n=1), Streptococcus spp. (n=1), Staphylococcus epidermidis (n=1) and Enterococcus faecalis (n=1). As indicated by study results, the incidence and mortality of SBP were high. Patients with liver cirrhosis and gastrointestinal hemorrhage were found to be at a high risk of developing sepsis with or without clinically proven SBP. The pathogens responsible for SBP were mostly gram-negative microorganisms; however, there were also a significant proportion of gram-positive microorganisms and hospital infections with antibiotic-resistant bacteria. Study results suggested the spectrum of pathogens to change due to the selection of antibiotic-resistant bacteria within the hospital setting.
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PMID:Prevalence and clinical outcome of spontaneous bacterial peritonitis in hospitalized patients with liver cirrhosis: a prospective observational study in central part of Croatia. 2063 79

Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication that occurs in patient with cirrhosis and ascites. It occurs in 10% to 30% of patients admitted to hospital. The organisms that cause SBP are predominantly enteric. Escherichia coli is the most frequent recovered pathogen, and Gram-positive bacteria, mainly Staphylococcus spp., are being considered an emerging causative agent of SBP. Streptococcus bovis that may be found as part of the commensal bowel flora in about 10% of healthy adults constitute an uncommon cause of peritonitis that was first reported in 1994. We describe the first case of SBP at the University Hospital of Santa Maria (HUSM) caused by S. bovis, resistant to the antibiotics erythromycin and clindamycin (inducible clindamycin resistance detected by disk diffusion test using the D-zone test).
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PMID:Spontaneous bacterial peritonitis caused by Streptococcus bovis: case report and review of the literature. 2083 16

Patients with cirrhosis present an increased susceptibility to bacterial infections, which are the cause of hospital admission in about 10% of patients and are present in about 40% of those admitted for ongoing complications. Lastly, about a third of patients develop nosocomial infections. Spontaneous bacterial peritonitis (SBP) is the most frequent infection in advanced cirrhosis; it is mostly caused by Gram-negative bacteria of intestinal origin, but Gram-positive cocci can be involved in nosocomial-acquired SBP. Its occurrence is associated with complications, such as renal and circulatory failure, cardiac dysfunction, coagulopathy, encephalopathy, and relative adrenal insufficiency, ultimately leading to multi-organ failure and death within a few days or weeks in about 30% of cases. The main mechanism underlying the development of SBP, as well as other bacterial infections in cirrhosis, is represented by bacterial translocation from the intestinal lumen to mesenteric lymph nodes or other extraintestinal organs and sites. This process is facilitated by several factors, including changes in intestinal flora, portal hypertension, and, mainly, impairment in local/systemic immune defense mechanisms. Bacterial infections in advanced cirrhosis evoke an enhanced systemic inflammatory response, which explains the ominous fate of PBS. Indeed, an exaggerated production of cytokines ensues, which ultimately activates vasodilating systems and generates reactive oxygen species. Primary antibiotic prophylaxis of PBS is warranted in those conditions implying an increased incidence of bacterial infections, such as gastro-intestinal bleeding and low protein content in ascites associated with severe liver and/or renal dysfunction. Fluoroquinolones are commonly employed, but the frequent occurrence of resistant bacterial strains make third generation cephalosporins preferable in specific settings. The high PBS recurrence indicates secondary antibiotic prophylaxis.
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PMID:Spontaneous bacterial peritonitis: from pathophysiology to prevention. 2086 73

One of the most common manifestations of the development of portal hypertension in the patient with cirrhosis is the appearance of ascites. Once ascites develops, the prognosis worsens and the patient becomes susceptible to complications such as bacterial peritonitis, hepatic hydrothorax, hyponatremia, and complications of diuretic therapy. As the liver disease progresses, the ascites becomes more difficult to treat and many patients develop renal failure. Most patients can be managed by diuretics which, when used correctly, will control the ascites. Spontaneous bacterial peritonitis can be treated effectively, but portends a worse prognosis. Once the ascites becomes refractory to diuretics, liver transplantation is the best option, although use of transjugular intrahepatic portosystemic shunts will control the ascites in many patients. Lastly, the development of hepatorenal syndrome indicates the patient's liver disease is advanced, and transplantation again is the best option. However, use of vasoconstrictors may improve renal function in some patients, helping in their management while they await a liver transplant.
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PMID:Management of refractory ascites and hepatorenal syndrome. 2108 Feb 46

We herein report a patient with decompensated cirrhosis secondary to autoimmune hepatitis, who presented with pneumatosis intestinalis (PI) and portal venous gas. Mesenteric ischemia has been recognized as a common and life-threatening cause of PI which portends a grave prognosis. The patient was found to have bacterascites and recovered after appropriate antibiotic therapy. Spontaneous bacterial peritonitis/bacterascites with gas-forming organisms manifesting as PI has not been previously reported.
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PMID:Pneumatosis intestinalis and mesenteric venous gas - a manifestation of bacterascites in a patient with cirrhosis. 2120 25


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