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How to reveal the truth about spontaneous bacterial peritonitis through ascitic fluid examination?
Spontaneous bacterial peritonitis (SBP) is a peritoneal infection that often presents a challenge to healthcare providers due to the lack of an obvious source of infection. This condition usually involves bacterial infection of the ascites fluid and is particularly common in patients with cirrhosis. In addition to cirrhosis, patients with nephrotic syndrome are at similar risk. Prompt diagnosis of this infection is crucial because the mortality rate of SRB is quite high.
If the ascitic fluid examination shows that the number of white blood cells exceeds 250 cells/μL, the infection can be confirmed and antibiotic treatment should be given immediately.
Characteristic symptoms of SBP include fever, chills, nausea, vomiting, abdominal pain and distension. According to research, about 13% of SBP patients have no obvious symptoms at the time of onset, which makes diagnosis more complicated. Worse, in patients with acute or chronic liver failure, SBP can become a major trigger of hepatic encephalopathy.
Diagnosis: Ascites examination that cannot be ignored
The key to confirming the diagnosis of spontaneous bacterial peritonitis lies in the examination of ascites. Doctors obtain ascites samples through abdominal puncture. If the number of white blood cells (especially neutrophils) increases abnormally, infection can be confirmed. This procedure is often called paracentesis.
Ascites examination can effectively improve the diagnostic rate of SBP. The existence of SBP can only be confirmed when there is no inflammation or perforation of other organs.
During inspection, if sterile containers are used for inspection, about 40% of samples can detect pathogens; but if culture media bottles are used, the sensitivity can increase to 72-90%. This emphasizes the importance of correct testing methods for the diagnosis of SBP.
Pathogenic mechanism: bacterial transfer and immune deficiency
Bacterial transfer is thought to be the primary mechanism leading to spontaneous bacterial peritonitis. Many people with cirrhosis have an overgrowth of bacteria in their small intestines, which may pass through the intestines and into the abdominal cavity. Regarding the impact on the immune system, patients with liver disease are often accompanied by insufficient immune function, which makes them more susceptible to infections. In addition to bacteria, spontaneous fungal peritonitis (SFP) may occur, a more complex condition that can make diagnosis further difficult.
In patients with SBP, if the ascites protein concentration is less than 1 g/dL, the risk of developing SBP increases tenfold.
Treatment model: prevention and prevention
Once diagnosed, treatment with antibiotics is the first step, usually with third-generation cephalosporins such as fluclothiazide. If there is a risk of renal dysfunction, albumin will often be injected at the same time, which can significantly reduce the chance of renal damage caused by hepatorenal syndrome. Hospital stay is often necessary to ensure patients are observed and treated effectively.
Additional gastrotropes may help reduce the incidence of spontaneous bacterial peritonitis, which may be related to reducing small intestinal bacterial proliferation.
Indefinite prophylactic antibiotics are necessary for patients who have had SBP in the past. In addition, studies have also shown that the use of rifaximin may effectively reduce the occurrence of SBP in patients with cirrhosis.
Conclusion: A long-term challenge
As the understanding of SBP gradually deepens, the challenges of facing this disease remain unabated. Early diagnosis and effective treatment are crucial, however, there are still many unknowns waiting to be explored. In this medical battle that is a race against time, have you also thought about how to make better use of existing medical resources when facing new challenges?
