4.3 J) Viii) Gastrointestinal Spontaneous Bacterial Peritonitis

Front 1

Which is incorrect regarding SBP

{spontaneous bacterial peritonitis}
A. The most common organism is E coli
B. Abdominal pain, fever, and altered mental status are the most

common symptoms.
C. Findings consistent with SBP on paracentesis include a PMN count of >100 cells/mm
D. It is treated with a third generation cephalosporin : eg. ceftriaxone

Back 1

C. SBP = PMN count > 250 cells/mm

Front 2

What are the 3 main organisms found with SBP?

Back 2

1. E coli
2. Streptococcus species
3. Klebsiella

Front 3

Which is incorrect regarding SBP?
A. It is usually seen in the setting of cirrhosis
B. 5% patients have no signs / symptoms of infection
C. Altered mental status is often present
D. Fever is the most common sign

Back 3

B. 13% have no signs / symptoms of infection.

Front 4

Which is incorrect regarding paracentesis for SBP?
A. It is the mainstay of diagnosis
B. At least 40mL should be aspirated
C. Coagulopathy does not require correction before procedure
D. Thrombocytopenia is not a contraindication to paracentesis

Back 4

D. Platelet count < 20 a contraindication.

Front 5

How much fluid should be aspirated with

paracentesis, and what for?

Back 5

40mL:

- 10mL per culture bottle
- 10mL for

1. Sterile container
2. Purple -EDTA
3. Red top-Serology

*cell count + * chemistries

Front 6

What are the important ascitic fluid assays in SBP?

Back 6

1. Cell count [ PMN > 250 cells/mm]
2. Protein [ < 1g/dL]
3. Albumin [ serum-ascites albumin gradient]
4. Culture and gram stain

*** dipstick leukocyte assay has excellent

negative predictive value for SBP

Front 7

Which is incorrect regarding SBP?
A. Alcoholic hepatitis = ascitic PMN count of < 250 cells/mm when

presenting symptoms are fever and abdominal pain , with ascites.
B. Avoid aminoglycosides in SBP
C. IV albumin helps in preventing renal impairment and reducing

mortality.
D. The mortality for SBP is high.

Back 7

D. Mortality actually is low for SBP itself.

Front 8

Which of the following is incorrect regarding SBP compared with CAPD?
A. CAPD peritonitis is diagnosed with the same PMN count as SBP: > 250 cells/mm
B. E coli is an uncommon cause of peritonitis in CAPD patients - it is

usually Staphylococcus [gram + 50% cases ]
C. Antibiotics are given in the intraperitoneal route for CAPD peritonitis
D. Abdominal pain + fever + cloudy peritoneal fluid occur in both SBP and CAPD peritonitis

Back 8

A. CAPD peritonitis = > 100 cells/mm

SBP > 250 cells/mm

Front 9

{Dunn} Risk Factors for SBP? [3]

Back 9

SBP Risk factors :

1. Hepatic cirrhosis with ascites
2. Nephrotic syndrome
3. Peritoneal dialysis [CAPD]

Front 10

{Dunn} Which is incorrect regarding the History of SBP?
A. Abdominal pain is present in 95% cases
B. Nausea, vomiting and diarrhoea do not occur
C. Confusion may be present
D. Fever is only 40% sensitive, with Temperature > 38 degrees in only 20% cases.

Back 10

B. All can be present.

Front 11

{Dunn} Which is incorrect regarding SBP?

A. Hepatic encephalopathy is present 25% cases
B. Cloudy ascitic fluid macroscopically is present in 95% cases.
C. A clear appearing ascitic tap can usually exclude SBP
D. Blood cultures are positive in 50% cases

Back 11

A. Hepatic encephalopathy present in 50%

Front 12

{Dunn} Which is incorrect regarding the

statistics of SBP ascitic fluid analysis?
A. a PMN count of > 250 umol/L has a LR+ of 6.4 , with 95% sensitivity for SBP
B. Protein count < 1 g/dL has a 50% sensitivity for SBP
C. WCC > 250 umol/L is 80% sensitive for SBP
D. WCC > 1000 umol/L has a positive Likelihood ratio of 9

Back 12

B. 100% sensitivity