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Spontaneous Bacterial Peritonitis

Spontaneous bacterial peritonitis is a common complication of liver cirrhosis patients with ascites. It is a kind of abdominal infection caused by pathogenic bacteria. Late-stage liver cirrhosis patients, severe hepatic patients and patients with nephrotic syndrome are more likely to develop spontaneous bacterial peritonitis. Because,the treatment is difficult,spontaneous bacterial peritonitis is one of the death causes of hepatic patients in late stage. The death rate of spontaneous bacterial peritonitis is among 48% to 57%. With the development of treatment level, the death rate decreases to 20% to 40% among liver cirrhosis patients in late stage.

The symptoms of liver cirrhosis patients with spontaneous bacterial peritonitis are:
1. Fever. Fever is the major symptoms.
2. Bellyache. It's often accompanied by loss of appetite, nausea, vomit and diarrhea.
3. Peritoneal irritation. Abdominal tenderness is what patients' feel.
4. Ascites. The speed of ascites accelerates. Patients feel anabatic abdominal distension. The diuretic does not work. Even patients breath with difficulty.

Besides, there are other complications of liver cirrhosis patients with spontaneous bacterial peritonitis, such as early hepatic encephalopathy, upper respiratory tract hemorrhage and do on. All can cause rapid deterioration of liver function or even death.

Liver cirrhosis accompanied by spontaneous bacterial peritonitis needs comprehensive treatment. The key is to effectively control infection, preventing hepatic encephalopathy and correcting water electrolyte disorder.

Antimicrobial therapy:

1.Empirical treatment:the third-generation cephalosporins(Ceftriaxone, cefotaxime, ceftazidime, cefoperazone);Amoxicillin / clavulanic acid;Fluoroquinolone antibiotics;Aminoglycosides such as amikacin;Aztreonam.

Bacterial drug resistance is not same in different areas and hospitals,it should have a local drug-resistant trends to adjust antibiotics timely.

2.Targeted anti-infection treatment: before acquiring pathogenic bacterium, using antibiotic by experience is the main way. Once the pathogenic is acquired, the antibiotic should be chosen according to the research result.

The treatment of Ascites: when diuretic loses its effect, the abdominal puncture treatment can be used. Simple paracentesis can lead to hypovolemia, hyponatremia, renal dysfunction and hepatic encephalopathy, so it's better to supplement enough protein along with large-volume paracentesis.

Albumin treatment: research shows that intravenous injecting albumin along with using antibiotic can decrease the incidence and mortality of renal insufficiency.

Supportive care
Do the intravenous nutrition support, excellent protein supplement( branched chain amino acids), strict control of blood glucose (<8mmol/L).

Experts Opinion

If patients with severe liver diseases show rapid deterioration of liver and kidney function, jaundice and hepatic encephalopathy, they should go to check whether they develop spontaneous bacterial peritonitis. Once diagnosed, they should receive antibiotic treatment at once and use albumin to improve curative effect. Liver cirrhosis patients with spontaneous bacterial peritonitis should consider take oral antibiotic for a long term to avoid the recurrence of spontaneous bacterial peritonitis.

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