What is spontaneous bacterial peritonitis?

One of the complications of low protein cirrhotic ascites, spontaneous infection of other form is rare, delay in dx and initiation of therapy carry high mortality. It occurs by translocation of bacteria across GI epithelium to lymphatics and then to peritoneal cavity (more risk for low prortien ascites <1g/dl) It presents as fever, jaundice, abdominal pain, confusion (70%), hypotension (25%) and maybe asymptomatic 35% of the time. Dx by PMN >250 (90% accurate), positive ascitic fluid culture, abscence of surgical source Most organisms involved are gram - bacilli (E.coli and Kleb - 70%), then comes gram + (Strep viridans - 25%) and then anaerobes (5%)