Ascites and spontaneous bacterial peritonitis: An Asian perspective

Abstract

Ascites is the most common complication of liver cirrhosis, and it develops as a consequence of portal hypertension and splanchnic vasodilatation. Depending on severity, management of ascites consists of diverse strategy, including dietary sodium restriction, diuretic therapy, repeated large-volume paracentesis with albumin infusion, transjugular intrahepatic portosystemic shunt, and liver transplantation. Recently, advances in medical therapy have been made with satavaptan, a V2 receptor antagonist, vasoconstrictors, such as clonidine, midodrine, or terlipressin, and other categories of drugs, including docarpamine and Chinese herbs. These drugs may serve as useful adjuncts to conventional diuretics in the management of ascites. Besides ascites itself, serious complications, such as spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome, frequently ensue in decompensated cirrhosis. SBP develops from the translocation of bacteria from the intestine, and successful management with early diagnosis and treatment with proper prevention in patients of high risk is necessary. In summary, ascites is a starting point for more serious complications in liver cirrhosis. Although liver transplantation is the fundamental treatment, it is not always feasible, and consequently various means of treatment should be used. Further study, particularly in Asia where hepatitis B virus-related cirrhosis is predominant, is warranted to improve the clinical outcome.

Serum Calprotectin as a Non-invasive Diagnostic Marker for Spontaneous Bacterial Peritonitis in Egyptian Cirrhotic Patients

“…Thus, an accurate biomarker for the early identification of SBP would be of great diagnostic value. Diagnosis of SBP is based on the presence of neutrophils more than 250/mm 3 in ascitic fluid (5) . Currently, differential cell count is usually performed by a manual method using light microscopy and counting chambers.…”

Study of bacterial flora and their antibiotic sensitivity in peritonitis of various causes

“…Intestinal bacterial overgrowth can also exacerbate the condition. 3,5 Studies have indicated that gram-negative Enterobacteriaceae such as Escherichia coli (E. coli) was the most common isolated organisms in SBP. 3,5,7 Diagnosis of SBP is established by an elevated ascitic fluid polymorphonuclear leukocyte (PMNL) count (≥250 cells/mm3).…”

“…3,5 Studies have indicated that gram-negative Enterobacteriaceae such as Escherichia coli (E. coli) was the most common isolated organisms in SBP. 3,5,7 Diagnosis of SBP is established by an elevated ascitic fluid polymorphonuclear leukocyte (PMNL) count (≥250 cells/mm3). 5,6 Some studies suggest that the type and the etiology of SBP have been changing in the recent years.…”

“…3,5,7 Diagnosis of SBP is established by an elevated ascitic fluid polymorphonuclear leukocyte (PMNL) count (≥250 cells/mm3). 5,6 Some studies suggest that the type and the etiology of SBP have been changing in the recent years. Involvement with gram-positive bacteria and increased frequency of multiple antibiotic resistant bacteria are evidences that support this viewpoint.…”

“…[3][4][5][6] SBP is defined as a monomicrobial infection of the ascitic fluid, which is not accompanied by a definite evidence of a surgically treatable origin. 3,5,6 The infection occurs following a translocation or hematogenous dissemination of the intestinal flora. Intestinal bacterial overgrowth can also exacerbate the condition.…”