Ascites and Spontaneous

Bacterial Peritonitis
Arthur Harris, MD
Attending, Division of Gastroenterology
Jacobi Medical Center/North Central Bronx Hospital
Assistant Professor of Medicine, AECOM
 Latest Physiopathology
• Increased resistance to hepatic flow
• Portal hypertension
• Production of splanchnic arterial
vasodilators (NO)
• Early cirrhosis
• Late cirrhosis
Consequences of vasodilatation
• Decreased effective plasma
volume
• Sodium retention
• Increased capillary permeability
 Ascites – Patient Evaluation

• Assess liver function

• Evaluation of renal and CVS function
• Ascitic fluid analysis
• Endoscopy for varices
 Therapy

It’s all about the sodium

Spontaneous Bacterial Peritonitis
 SBP – Antibiotic Therapy I

•IV Cefotaxime 2g q8 hours or

Ceftriaxone 2g q24hours
•Duration of therapy unclear
– 2 weeks suggested if Blood cultures(+)
– If repeat paracentesis at 48 hours shows
PMN ≤ 250/μL, then 5-7 days of
treatment may be adequate
 SBP – Antibiotic Therapy II
• Prophylactic antibiotics should also be
prescribed indefinitely until ascites
has eliminated
• Options include:
-Cotrimoxazole DS 960mg orally 5
days/week
-Ciprofloxacin 750mg orally q week