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

The evaluation of ascites includes a directed history, focused physical examination, and diagnostic paracentesis with ascitic fluid analysis. Dietary sodium restriction and oral diuretics are the mainstay of therapy for the majority of patients with cirrhotic ascites. Transjugular intrahepatic portocaval shunt has emerged as the treatment of choice for selected patients with refractory ascites, although serial large-volume paracenteses should be attempted first. Early diagnosis, broad-spectrum antibiotics, and albumin infusion contribute to the successful management of spontaneous bacterial peritonitis (SBP). Referral for liver transplant evaluation should be considered at the first sign of decompensation and should not be delayed until development of ominous clinical features, such as refractory ascites and SBP.
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PMID:Management of ascites. 1138 75

Ascites is the most common presentation of decompensated cirrhosis, and its development heralds a poor prognosis, with a 50% 2-year survival rate. Effective first-line therapy for ascites includes sodium restriction (2 g/d), use of diuretics, and large-volume paracentesis (LVP). Ideally, a combination of a loop-acting diuretic (eg, furosemide) and a distal-acting diuretic (eg, spironolactone) is used. LVP has the advantage of producing immediate relief from ascites and its associated symptoms. When 5 L or more ascitic fluid is removed, albumin (6 to 8 g per liter of fluid removed) should be administered intravenously to minimize hemodynamic and renal dysfunction. The development of refractory ascites is particularly ominous, and 50% of such patients die within 6 months of its development. Liver transplantation is the only effective therapy for patients with refractory ascites associated with cirrhosis; unfortunately, this therapy is not available for many of those with refractory ascites. Other therapies that are available include LVP, peritoneovenous shunts, and transjugular intrahepatic portasystemic shunts (TIPS). LVP alleviates ascites rapidly, but ascites recurs universally, requiring repeated hospitalizations and paracenteses and decreasing patient quality of life. Peritoneovenous shunts rarely are used due to their high complication rate and tendency to become occluded. Recently, the use of TIPS has been shown to be an effective therapy for patients with refractory ascites. It is most effective when liver function is relatively well preserved. On the other hand, TIPS may hasten death in those with advanced liver failure. TIPS has not been shown to have a clear-cut beneficial effect on survival in patients with refractory ascites. Spontaneous bacterial peritonitis is the most common complication of ascites and is associated with a worsening hyperdynamic circulation and a mortality rate of approximately 20%. Following an episode of spontaneous bacterial peritonitis, the 1-year mortality rate approaches 70%. Patients at risk should be considered for prophylaxis with an orally administered quinolone (eg, norfloxacin). Alternatives include trimethoprim/sulfamethoxazole. Active spontaneous bacterial peritonitis should be treated with an intravenously administered third-generation cephalosporins (eg, cefotaxime) in most circumstances.
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PMID:Ascites. 1169 79

For patients with refractory ascites, paracentesis is the standard therapy and for many it is the only treatment option. When more than five litres of ascitic fluid are removed, the use of a plasma expander effectively prevents "postparacentesis circulatory dysfunction", which is associated with a high mortality. Randomised controlled studies show that albumin is more effective than synthetic plasma expanders in the prevention of this complication. In selected patients with ascites, long-term administration of albumin may improve the diuretic response. A randomised controlled study in patients with spontaneous bacterial peritonitis has demonstrated that treatment with albumin infusion in addition to an antibiotic reduces the incidence of hepatorenal syndrome. Albumin infusion in combination with the administration of a vasopressin analogue may be able to reverse established hepatorenal syndrome; however, no controlled studies have been published. Whereas the use of albumin infusion with large-volume paracentesis is strongly supported by the available evidence, additional conclusive studies of the use of albumin for spontaneous bacterial peritonitis are awaited.
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PMID:[The use of albumin infusion in decompensated liver cirrhosis]. 1189 6

The objective of the study was to assess the prevalence and more detailed data pertaining to the incidence of spontaneous bacterial peritonitis (SBP) in the Czech Republic. The authors examined 99 patients with cirrhosis of the liver and ascites. SBP was diagnosed in a high percentage--35 patients, i.e. 35.4%. It was found more frequently in patients with an alcoholic etiology of cirrhosis who had a history of subfebrile and febrile temperatures and increasing trend of ascites. For the diagnosis the increase of leucocytes in serum and C reactive protein levels may prove useful. Lower values of total protein and albumin in ascites predispose to the development of this infection. Reduction of the number of thrombocytes in the group of patients with SBP indicates the influence of portal hypertension in the etiology of this disease.
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PMID:[Spontaneous bacterial peritonitis in the Czech Republic]. 1194 16

Patients with nephrotic syndrome (NS) are at increased risk for infection. Peritonitis is difficult to diagnose in the absence of peritoneal fluid analysis and empiric therapy carries significant risks. We identified factors present at initial presentation that are associated with an increased risk for the later development of spontaneous bacterial peritonitis in children with NS. A case-control study of patients admitted to Children's Hospital and Regional Medical Center, Seattle from 1989 to 1999 with a diagnosis of NS was conducted; 8 cases of NS and peritonitis (aged 20-113 months) and 24 controls with NS alone (aged 10-193 months) were identified and matched on year of diagnosis of NS. Medical charts were reviewed and laboratory values at the time of initial presentation of NS were recorded. Odds ratios (OR) were estimated, Fischer's exact test was used to obtain P values, and 95% exact confidence intervals (CI) were also calculated. Cases tended to be younger than controls (mean age 50.5 months vs. 65.3 months), and were more likely to be white and male. There was a suggestion of an association between serum albumin level at presentation and the risk of subsequent peritonitis. Those patients with a serum albumin level less than or equal to 1.5 g/dl at initial presentation were estimated to have a 9.8-fold (95% CI 0.93, 472; P=0.06) increase in the odds of developing peritonitis than those with an initial albumin greater than 1.5 g/dl. A platelet count greater than 500 cells/mm(3)tended toward a reduced risk (OR=0.12, 95% CI 0.002,1.29; P=0.10) for subsequent peritonitis when compared with patients with a platelet count less than 500 cells/mm(3), but was not statistically significant. Hypertension, hematuria, or normal serum complement levels (C3, C4) at the time of initial diagnosis were not associated with an increased risk of subsequent peritonitis. Low serum albumin (< or = 1.5 g/dl) at presentation was associated with an increased risk of peritonitis among children with NS at our institution.
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PMID:Predictors of peritonitis in children with nephrotic syndrome. 1218 81

Renal function abnormalities and ascites in cirrhosis are the final consequence of a circulatory dysfunction characterized by marked splanchnic arterial vasodilation. This causes a reduction in effective arterial blood volume and the homoeostatic activation of vasoconstrictor and sodium-retaining systems. Albumin is very effective in preventing renal failure associated with large-volume paracentesis and spontaneous bacterial peritonitis, conditions that are known to cause an impairment of circulatory function in patients with cirrhosis and ascites. Moreover, albumin administration improves survival in patients with spontaneous bacterial peritonitis. In patients with hepatorenal syndrome the administration of vasoconstrictor drugs in combination with albumin improves circulatory and renal function markedly and survival slightly. By contrast, the administration of albumin without vasoconstrictors has marginal or no effects on renal function in this setting.
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PMID:Review article: albumin for circulatory support in patients with cirrhosis. 1242 50

Ascites accumulation is the product of a complex process involving hepatic, renal, systemic, hemodynamic, and neurohormonal factors. The main pathophysiologic theories of ascites formation include the "underfill," "overflow," and peripheral arterial vasodilation hypotheses. These theories are not necessarily mutually exclusive and are linked at some level by a common pathophysiologic thread: The body senses a decreased effective arterial blood volume, leading to stimulation of the sympathetic nervous system, arginine-vasopressin feedback loops, and the renin-angiotensin-aldosterone system. Cornerstones of ascites management include dietary sodium restriction and diuretics. Spironolactone is generally tried initially, with furosemide added if clinical response is suboptimal. More refractory patients require large-volume paracentesis (LVP) accompanied by volume expansion with albumin. Placement of a transjugular intrahepatic portosystemic shunt is reserved for individuals with compensated liver function who require very frequent sessions of LVP. Peritoneovenous shunts are not used in contemporary ascites management. Liver transplantation remains the definitive therapy for refractory ascites. Although treatment of ascites fails to improve survival, it benefits quality of life and limits the development of such complications as spontaneous bacterial peritonitis.
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PMID:Pathophysiology and management of pediatric ascites. 1273 47

The aim of the study was to determine the prevalence and detailed data concerning the incidence of spontaneous bacterial peritonitis in the Czech Republic. Ninety-nine patients with liver cirrhosis and ascites were examined. Spontaneous bacterial peritonitis was diagnosed in 35 patients (35.4%). It was revealed more often in patients with alcoholic aetiology of cirrhosis whose anamnesis involved sub-febrile or febrile states and the deterioration of ascites. Elevated serum leucocyte counts and increased levels of C-reactive protein can contribute to the diagnosis. A low level of total protein and albumin in ascites predisposes to the increase of this infection. The reduction of the platelet count in a set of patients with spontaneous bacterial peritonitis indicates the influence of portal hypertension in the aetiology of the disease.
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PMID:Spontaneous bacterial peritonitis in the Czech Republic: prevalence and aetiology. 1281 4

In recent years, the use of vasopressin analogues in the treatment of hepatorenal syndrome has become an effective therapeutic strategy leading to improved survival and often allowing the completion of liver transplantation. Terlipressin, in particular, has proven to be safe and effective. Due to the limited number of patients treated so far, it is, however, difficult to draw any definite conclusions on the optimal dosage and on the occurrence of side-effects in these patients. The case is reported of an ascitic cirrhotic patient who developed spontaneous bacterial peritonitis followed by a type-I hepatorenal syndrome. Treatment with terlipressin boluses (0.5 mg/4 h) associated with albumin infusion was then started. The course of the disease was monitored by clinical and laboratory means. After 10 boluses of terlipressin, rectorrhagia and severe ischaemic complications involving the skin of the abdomen, lower limbs, scrotus, and penis, occurred. These ischaemic complications improved after terlipressin withdrawal, while renal failure evolved leading to the patient's death. This case report shows that, in patients with type-I hepatorenal syndrome, the use of terlipressin, even at low dosages, may induce life-threatening ischaemic complications and, moreover, suggests that the recent occurrence of spontaneous bacterial peritonitis, even if properly treated, may significantly increase the risk of major ischaemic complications.
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PMID:Is spontaneous bacterial peritonitis an inducer of vasopressin analogue side-effects? A case report. 1287 Jul 38

A decreased effective arterial blood volume is the principal haemodynamic disturbance in cirrhosis, leading to activation of the renin angiotensin aldosterone and the sympathetic nervous systems, sodium and water retention and renal impairment. Albumin is a plasma expander that could be used in clinical settings in cirrhosis in which plasma expansion would reverse some of the decreased effective arterial blood volume, or prevent its iatrogenic (i.e., paracenteses) or spontaneous worsening (spontaneous bacterial peritonitis). However, apart from the issue of transmission of prion agents, which may become an important issue in clinical risk management of the use of albumin in the future, the problem with albumin is its expense. Every effort must thus be made to definitely prove albumin is always the best colloid for all clinical settings in cirrhosis. Further randomized trials are justified.
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PMID:Is the use of albumin of value in cirrhosis? The case not so in favour, or is there an alternative? 1456 92


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