1 / 25

Ascites and Spontaneous Bacterial Peritonitis

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

maisie
Télécharger la présentation

Ascites and Spontaneous Bacterial Peritonitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Ascites and Spontaneous Bacterial Peritonitis Arthur Harris, MD Attending, Division of Gastroenterology Jacobi Medical Center/North Central Bronx Hospital Assistant Professor of Medicine, AECOM

  2. Latest Physiopathology • Increased resistance to hepatic flow • Portal hypertension • Production of splanchnic arterial vasodilators (NO) • Early cirrhosis • Late cirrhosis

  3. Consequences of vasodilatation • Decreased effective plasma volume • Sodium retention • Increased capillary permeability

  4. Ascites – Patient Evaluation • Assess liver function • Evaluation of renal and CVS function • Ascitic fluid analysis • Endoscopy for varices

  5. Therapy It’s all about the sodium

  6. Spontaneous Bacterial Peritonitis

  7. SBP – Antibiotic Therapy I • Initiate for PMN≥250/mm3 • 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/mm3, then 5-7 days of treatment may be adequate

  8. SBP – Antibiotic Therapy II • Prophylactic antibiotics should also be prescribed indefinitely until ascites has eliminated • Options include: -Bactrim DS 1 tab po 5 days/week -Cipro 750mg po q week

More Related