Incidence of spontaneous bacterial peritonitis and its variants with specific reference to its outcome on disease progression and mortality.

Sathya, G (2013) Incidence of spontaneous bacterial peritonitis and its variants with specific reference to its outcome on disease progression and mortality. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION : Spontaneous bacterial peritonitis is the most frequent and important complication of cirrhosis with ascites. SBP is most frequently seen in severely decompensated cirrhotic patients. Since the infection occurs in the absence of a contiguous source of infection like intra – abdominal inflammatory focus eg: abscess, acute pancreatitis, cholecystitis, intestinal perforation, it is called Spontaneous. Based on culture, polymorphonuclear neutrophil counts of the ascitic fluid and the presence or absence of a surgical source of infection, ascitic fluid infection can be catagorized into five types. There are three types of spontaneous ascitic fluid infections. Spontaneous bacterial peritonitis is the prototype among them. SBP accounts for 25% of all infections and 9% of hospitalised patients with cirrhosis. When a cirrhotic patient, particularly with encephalopathy and or jaundice detoriates, SBP should be suspected. An ascitic fluid protein of less than 1 g/dl predisposes to SBP. Patients with a previous episode of SBP are at a particular risk. Patients with variceal bleeding are also at high risk of developing SBP. Systemic vascular changes in response to the infection can lead to renal complications in patients with SBP. Prognosis is worse in patients with SBP. They have a high morbidity and mortality. 10% to 20% of patients die during that hospital admission. The median survival of a patient who develops SBP is approximately 9 months. SBP recurrence is also not uncommon. The 1 year probability of SBP recurrence is 69%. In patients with uncomplicated SBP (i.e. no renal dysfunction, no encephalopathy), SBP resolution and immediate survival is 100 %, whether the patients receive oral or intravenous antibiotics. Recurrent SBP in a cirrhotic patient with ascites is an indication for hepatic transplantation, because of reduced survival. AIM : 1) To determine the Incidence, Microbial spectrum, Clinical and Biochemical spectrum of SBP and its variants in patients with Cirrhosis and Ascites. 2) To study the natural history and outcome of patients with SBP CONCLUSION : SBP is seen in 29% of patients with cirrhosis and ascites. Classic SBP is seen in one – third and CNNA in two – thirds of the patients with SBP. E coli is the commonest organism grown. Next is Klebsiella. SBP is common in alcoholic cirrhotics. Low ascitic fluid protein levels, high sr bilirubin, high INR, high MELD score and Child class C are risk factors for SBP. Abdominal pain, Fever are common in patients with SBP. SBP can be fatal in patients with cirrhosis and ascites. The mortality in patients with culture positive SBP (Classic SBP) is more frequent than with culture negative SBP (CNNA).

Item Type: Thesis (Masters)
Uncontrolled Keywords: spontaneous bacterial peritonitis ; progression ; mortality.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 14 Jul 2017 03:10
Last Modified: 14 Jul 2017 03:10
URI: http://repository-tnmgrmu.ac.in/id/eprint/1615

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