goodduck

1. S:  no apparent source.
    B:  >300 PMNs/mL
    P: abdominal pain, fever, ileus, diarrhea, abd tenderness,

         # alter MS

2. liver disease / portal circulation alter -> blood filtration decrease -> bacteremia -> bacteria to ascites
    -> lower level of complement -> opsonize decrease -> phagocytic property diminish -> good medium!

    cirrhosis(alcoholic), hepatitis(acute/chronic), CHF, SLE, metaststic malignancy, lymphedema

3. if have SBP -> almost all have ascites
     if have cirrhosis ->  less than 10% have SBP 

4.  G(-) bacilli :E.coli
     G(+) : streptococcus, enterococcus, pneumococcus
    -> single w/o anaerobic is more likely
    -> key:  mixed flora + anaerobic -> secondary!!

5. Plan:
    a. bacteremia -> blood culture
    b. peritoneal fluid culture ->analysis PMNs number /  bacteria types
    c. CT w/ contrast -> find out intraabdominal source
    d. CXR/ KUB -> exclude free air when abd pain, limited useful

6. Tx:
    a. emperical: cover G(+) cocci and G(-) aerobic bacilli, anaerobic is not necessary!
        -> cefotaxmie
    b. in a yr -> 70% recurrent ->prophylactic use!
        -> ciprofloxacin