Template:Diagnosis of SBP: Difference between revisions
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===Diagnosis of [[SBP]] | ===Diagnosis of [[SBP]] via [[Ascitic Fluid Analysis]]=== | ||
====Standard Evaluation==== | |||
*Paracentesis results supporting a diagnosis of SBP: | *Paracentesis results supporting a diagnosis of SBP: | ||
**Absolute neutrophil count (PMNs) ≥250, pH <7.35, OR blood-ascites pH gradient >0.1<ref>Wilkerson R, Sinert, R. The Use of Paracentesis in the Assessment of the Patient With Ascites. Ann Emerg Med 2009, 54(3): 465-68.</ref> | |||
**Absolute neutrophil count (PMNs) > | |||
**Bacteria on [[gram stain]] (single type) | **Bacteria on [[gram stain]] (single type) | ||
**SAAG > 1.1 | **SAAG > 1.1 | ||
***Diagnostic of portal hypertension with 97% accuracy<ref>Runyon BA, Montano AA, Akriviadis EA, et al. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med 1992; 117:215.</ref> | |||
***SBP rarely develops in patients without portal hypertension | |||
**Protein < 1, Glucose > 50 (otherwise concern for secondary bacterial peritonitis) | **Protein < 1, Glucose > 50 (otherwise concern for secondary bacterial peritonitis) | ||
''For bloody tap, subtract 1 WBC for every 250 RBC<ref>Hoefs JC "Increase in ascites white blood cell and protein concentrations during diuresis in patients with chronic liver disease."Hepatology. 1981;1(3):249. PMID 7286905</ref> | |||
====If on peritoneal dialysis==== | |||
''See [[Peritoneal dialysis-associated peritonitis]]'' | |||
*Cell count >100/mm with >50% neutrophils most consistent with infection<ref>ISPD GUIDELINES/RECOMMENDATIONS http://www.ispd.org/guidelines/articles/update/ispdperitonitis.pdf</ref> | |||
Latest revision as of 16:24, 26 June 2018
Diagnosis of SBP via Ascitic Fluid Analysis
Standard Evaluation
- Paracentesis results supporting a diagnosis of SBP:
- Absolute neutrophil count (PMNs) ≥250, pH <7.35, OR blood-ascites pH gradient >0.1[1]
- Bacteria on gram stain (single type)
- SAAG > 1.1
- Diagnostic of portal hypertension with 97% accuracy[2]
- SBP rarely develops in patients without portal hypertension
- Protein < 1, Glucose > 50 (otherwise concern for secondary bacterial peritonitis)
For bloody tap, subtract 1 WBC for every 250 RBC[3]
If on peritoneal dialysis
See Peritoneal dialysis-associated peritonitis
- Cell count >100/mm with >50% neutrophils most consistent with infection[4]
- ↑ Wilkerson R, Sinert, R. The Use of Paracentesis in the Assessment of the Patient With Ascites. Ann Emerg Med 2009, 54(3): 465-68.
- ↑ Runyon BA, Montano AA, Akriviadis EA, et al. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med 1992; 117:215.
- ↑ Hoefs JC "Increase in ascites white blood cell and protein concentrations during diuresis in patients with chronic liver disease."Hepatology. 1981;1(3):249. PMID 7286905
- ↑ ISPD GUIDELINES/RECOMMENDATIONS http://www.ispd.org/guidelines/articles/update/ispdperitonitis.pdf