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Query: UMLS:C0341503 (bacterial peritonitis)
 1,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Critical considerations are expressed on scientific approach to liver cirrhosis, a nosological entity based on both analytical inquiry and long term observation of a large number of cirrhotic patients. The main points taken into consideration are: the etiopathogenesis of cirrhosis; a systematic of diagnostic elements; some preventional aspects of the disease and of its major sequelae. In the histogenetical analysis, the following steps are identified and analysed: a) hepatocellular death (necrosis), b) inflammatory process, c) fibrosis, d) hepatocellular regeneration and disorganized vascular architecture as a consequence of nodular regeneration. The hepatotoxic action of the three most studied and widespread etiologic agents of cirrhosis, alcohol, HBV, iron, is also considered. Finally, as a last pathogenetic step and peculiar to liver cirrhosis, the complex vascular rearrangement that leads to a relative increase of the liver blood flow is analysed. Clinical experience suggests a distinction between active and inactive liver cirrhosis. In the former we find a chronic active hepatitis associated with nodular regeneration and subsequent compensatory blood flow rearrangement. No signs of chronic active hepatitis can be found in the latter which is characterized by irreversible alteration of the liver architecture, reduction of the liver function and hemodynamic rearrangement (portal and arterial). Both nosologic entities can be either clinically characterized or not by symptoms of the major sequelae and complications of cirrhosis. On the basis of the clinical experience, among the complications of cirrhosis spontaneous bacterial peritonitis, gastrointestinal bleeding, hepatorenal syndrome and hepatocarcinoma appear to have a great prognostic value. Association between hepatocarcinoma and liver cirrhosis, which seems to be independent of single etiologic factors of cirrhosis itself, also has a great reliance.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Epistemology of liver cirrhosis]. 227 60

Repeated large-volume paracentesis (4-6 L/day) is an effective and safe therapy of ascites in patients with cirrhosis provided albumin is infused intravenously. To investigate whether ascites can be safely mobilized in only one paracentesis session ("total paracentesis"), 38 cirrhotic patients with tense ascites were treated with total paracentesis plus intravenous albumin (6-8 g/L ascites removed). Standard liver tests and renal function tests, glomerular filtration rate, free water clearance, plasma volume, plasma renin activity, and plasma aldosterone and norepinephrine concentrations were measured before and after treatment. Total paracentesis was effective in mobilizing ascites in all but 1 patient and did not impair any of the parameters studied. The volume of ascitic fluid removed and the duration of the procedure were 10.7 +/- 0.5 L (mean +/- SEM) and 60 +/- 3 min, respectively. Five of the 38 patients (13%) developed complications during the first hospital stay (hepatic encephalopathy and gastrointestinal hemorrhage in 2 patients each and culture-negative bacterial peritonitis in 1). No patient developed renal impairment. This complication rate, as well as the clinical course of the disease during follow-up, estimated by the probability of readmission to hospital, causes of readmission, and survival probability after treatment, was similar to that reported in patients treated with repeated large-volume paracentesis. These results indicate that total paracentesis associated with intravenous albumin can be safely performed in cirrhotic patients with tense ascites and suggest that these patients could be treated in a single-day hospitalization regime.
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PMID:Total paracentesis associated with intravenous albumin management of patients with cirrhosis and ascites. 229 73

Usually, ascending cholangitis is a bacterial process. However, in the debilitated or immunocompromised patient, mycotic cholangitis must be placed in the differential diagnosis. We report a patient with cryptogenic cirrhosis whose presenting problem in his terminal hospitalization was spontaneous bacterial peritonitis, for which he was treated with broad-spectrum antibiotics. Endoscopic retrograde cholangiopancreatogram was performed during the hospital course to explain his profound hyperbilirubinemia. The findings were grossly consistent with primary sclerosing cholangitis or cholangiocarcinoma. The patient subsequently continued to deteriorate, and died with hepatic and renal failure. At autopsy, he was found to have choledocholithiasis, marked biliary duct proliferation, and ascending cholangitis, with Trichosporon demonstrated histologically to be invading the bile ducts. To our knowledge, this is the first reported case of Trichosporon cholangitis.
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PMID:Trichosporon cholangitis associated with hyperbilirubinemia, and findings suggesting primary sclerosing cholangitis on endoscopic retrograde cholangiopancreatography. 229 69

Although it is a relatively rare cause of peritonitis, Listeria monocytogenes must be considered in cirrhotic patients with ascites and a suggestive clinical presentation. We believe this is the first report of a case of peritonitis due to L monocytogenes in a patient without sepsis, and the sixth reported case of bacterial peritonitis in a patient with cirrhosis.
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PMID:Secondary bacterial peritonitis due to Listeria monocytogenes after paracentesis. 230 4

Spontaneous bacterial peritonitis in cirrhosis is a serious complication that demands urgent attention. We report here a prospective study of the treatment of 27 episodes of spontaneous bacterial peritonitis in 22 cirrhotic patients with amoxicillin and clavulanic acid. The infection of ascitic fluid was diagnosed by a positive culture plus an ascitic neutrophil count exceeding 75/microliters, or by an ascitic neutrophil count exceeding 500/microliters. The infection was treated with 1 gm amoxicillin and 0.2 gm clavulanic acid every 6 hr for 14 days. In 17 cases (63%), bacteria were isolated from the ascitic fluid. All the bacteria isolated were sensitive to amoxicillin and clavulanic acid, whereas in five cases they were resistant to amoxicillin alone (Escherichia coli in two cases, Klebsiella pneumoniae in two cases and Bacteroides fragilis in one case). Cure of the infection was achieved in 23 episodes (85%) after 14 days' treatment; 17 patients (63%) were able to leave the hospital. Fourteen of 20 patients (70%) treated for the first episode of infection died within 1 yr: eight from infection, two from gastrointestinal hemorrhage, one from infection and hemorrhage and three from tumors. One patient who had repeated infections underwent liver transplantation and has not had any infectious complications 1.5 yr after surgery. Amoxicillin and clavulanic acid may be an effective first-line therapy for ascitic fluid infection in cirrhosis. Nevertheless, the 1-yr prognosis continues to be grave and the severity of the underlying liver disease remains the most important determinant for survival.
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PMID:Amoxicillin-clavulanic acid therapy of spontaneous bacterial peritonitis: a prospective study of twenty-seven cases in cirrhotic patients. 231 50

The aim of this study was to test the diagnostic value of ascitic fluid cholesterol and triglycerides concentrations and of serum-ascites albumin concentration gradient in the differentiation between cirrhotic and malignant ascites. These biological parameters were determined, on the one hand in 34 cirrhotic patients, 6 of them having an hepatocellular carcinoma and 6 others having a spontaneous bacterial peritonitis and, on the other hand, in 16 patients with malignant ascites, 13 of them having an abdominal extra-hepatic or pelvic cancer, and 3 others having an extra-abdominal cancer with multiple liver metastases. Ascitic carcinoembryonic antigen assay and ascitic fluid cytology were also done in the 50 patients. In differentiating the cirrhotic patients from those with malignancy, ascitic fluid cholesterol concentration (discriminating value less than 1.1 mmol/l) ascitic fluid triglycerides concentration (discriminating value 0.5 mmol/l) and serum-ascites albumin concentration gradient (discriminating value greater than 11 g/l) allowed a diagnostic efficiency of 0.92, 0.80 and 0.77, respectively. Ascitic fluid cytology showed presence of malignant cells in 3/6 patients with hepatocellular carcinoma associated with cirrhosis, in 9/16 patients having a malignant ascites, and was negative in other patients. Ascitic carcinoembryonic antigen assay was abnormal only in 3/16 patients with malignant ascites. These results suggest that measurement of ascitic fluid cholesterol concentration must be included in the initial evaluation of patients with ascites of unknown origin.
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PMID:[Concentration of lipids in ascitic fluid and the concentration gradient of albumin in blood and ascites: diagnostic significance]. 261 52

Bacterial infection is a serious and often fatal complication of patients with liver disease and can prove fatal either directly or by precipitation of gastrointestinal bleeding, renal failure, or hepatic encephalopathy. At greatest risk are patients with alcoholic cirrhosis or decompensated chronic liver disease, or cases of acute liver disease who progress to fulminant hepatic failure or subacute hepatic necrosis. Infection appears to be unusual in patients with primary biliary cirrhosis. The site and type of infection is unrelated to the aetiology of the liver disease. Bacteraemia, pneumonia, urinary tract infection and spontaneous bacterial peritonitis are most common but infective endocarditis and meningitis, especially with pneumococci, are easily overlooked. Clinical suspicion of infection must be high as the only indication may be a general deterioration in the patients' clinical state, increasing encephalopathy or renal impairment. In the case of patients with fulminant hepatic failure, infection may precipitate the initial or recurrent encephalopathy and contributes to death in 10% of fatal cases. Spontaneous bacterial peritonitis is now recognized to occur in the absence of clinical features of peritonitis. The PMN content of the ascitic fluid may provide the only indication of infection and is the most readily available screening test. The most common types of organism responsible for all types of infection are Gram-negative enteric and streptococci, especially pneumococci, while infection with anaerobes is rare. Risk factors for infection include decompensated alcoholic liver disease, fulminant hepatic failure, gastrointestinal bleeding, invasive practical procedures and impaired host defence mechanisms against infection. Of the host defence mechanisms, impaired function of the reticuloendothelial system, complement, and PMNs represent the most common and serious defects. Defects of humoral immunity are present in ascitic fluid from patients with cirrhosis and are probably a major reason for development of spontaneous bacterial peritonitis. Diuresis improves these functions and reduces the risk of peritonitis. Treatment of infections even with the appropriate antibiotic is still associated with a high mortality but the use of adjuvant gut sterilization is promising, particularly in cases infected with Gram-negative enteric organisms. Infusions of fresh frozen plasma, blood and cryoprecipitate improve some systemic host defences and may be beneficial in the treatment and reduction of risk of infection.
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PMID:Bacterial infections complicating liver disease. 265 49

Therapeutic paracentesis has recently been reported to eliminate ascites in patients with cirrhosis more rapidly than diuresis. However, diuresis has been shown to increase ascitic fluid opsonic activity. Patients with adequate ascitic fluid opsonic activity have been reported to be protected from spontaneous bacterial peritonitis. In this randomized controlled trial, 19 patients with cirrhotic ascites were treated with diuresis versus daily therapeutic paracenteses during 20 hospitalizations. Serum and ascitic fluid complement concentrations and ascitic fluid opsonic activity were measured at the beginning and end of treatment. Although opsonic activity increased significantly (p less than 0.01) in patients treated with diuresis, this parameter was stable in the paracentesis group. The stability of the ascitic fluid opsonic activity and complement concentration in the paracentesis group were maintained at the expense of a decrease in serum complement, whereas serum and ascitic fluid complement increased in the diuresis group. Diuresis may have the advantage over therapeutic paracentesis of providing better protection from spontaneous bacterial peritonitis. Study of larger numbers of patients will determine if these changes in complement concentrations and opsonic activity translate into an increased risk of spontaneous bacterial peritonitis in vivo.
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PMID:Effect of diuresis versus therapeutic paracentesis on ascitic fluid opsonic activity and serum complement. 265 62

In summary, the diagnosis of ascites should be considered in all patients presenting with abdominal distention. A careful history and physical examination should be performed to rule out conditions that mimic ascites. Ultrasonography should be performed in questionable cases of ascites since physical examination and radiographic signs of ascites are unreliable. Paracentesis can help determine the etiology. Ascitic fluid should be examined to rule out spontaneous bacterial peritonitis, one of the few curable complications of cirrhosis. An ascitic fluid PMN count of greater than 250 per mm3 proves a sensitive indicator of infection. Medical treatment of cirrhotic ascites includes dietary sodium restriction and diuretics++. Large-volume paracentesis, with or without the use of colloid infusions, may provide useful adjunctive therapy. In rare instances, intractable ascites may be treated with a peritoneovenous shunt, although the complications and mortality rate of this procedure are significant. Peritoneovenous shunting, however, has not been shown to improve survival.
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PMID:Ascites. 266 63

Primary peritonitis, or spontaneous bacterial peritonitis, is a highly morbid and often fatal complication of cirrhosis and other conditions associated with ascites. Prompt antibiotic therapy may be lifesaving, as may early surgical intervention in patients who have signs and symptoms of an acute abdomen. During a 5-year period, 12 patients had 14 episodes of primary peritonitis diagnosed in our hospital. Three patients had exploratory laparotomy, and gram-positive organisms were obtained from peritoneal fluid in two patients. The clinical features, patho-physiology, and natural courses of these patients are presented and the current literature reviewed.
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PMID:Primary peritonitis. An unusual operative diagnosis. 268


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