Definition: Acute infection of the ascitic fluid in a patient with liver disease without another source of infection

Epidemiology: (Runyon 1988, Runyon 1988, Borzio 2001)

20% risk in those with ascites admitted to the hospital

10-25% risk of at least one episode per year

Pathophysiology:

Classic triad: fever, abdominal pain and increasing ascites. Presence of all three components uncommon

F) or abdominal pain/tenderness, empiric antibiotics should be given even if neutrophil count < 250 cells/mm

Due to variable presentations and considerable mortality associated with SBP, consideration should be made to perform paracentesis on ALL patients with ascitic fluid who are being admitted ( Gaetano 2016

Serum blood tests (i.e. WBC, CRP, ESR) are not helpful in making this diagnosis

Obtaining an ascitic fluid sample is critical in making the diagnosis

Patients with a single episode of SBP should be considered for antibiotic prophylaxis (with norfloxacin, ciprofloxacin or TMP/SMX) ( Runyon 2012

Presence of any of the following should prompt albumin administration

Recommended by American Association for the Study of Liver Disease (AASLD) in specific subgroups with SBP

SBP is a difficult diagnosis to make because presentations are variable. Consider a diagnostic paracentesis in all patients presenting to the ED with ascites from cirrhosis

An ascites PMN count > 250 cells/mm 3 is diagnostic of SBP but treatment should be considered in any patient with ascites and abdominal pain or fever