Asymptomatic Spontaneous Bacterial Peritonitis in Liver Cirhosis With Ascitis

Abstract

Objective: To asses the  frequency of asymptomatic spontaneous bacterial  peritonitis  in  liver  cirrhotic  patients  
with   first  presentation  of  ascities. 
Study Design: A descriptive case series study.  
Place and duration of Study:  This study was conducted at the Department of Medicine, Peoples Medical College 
Nawabshah from 1st September 2007 to 28th February 2008. 
Patients and Methods: In this study 100 patients of cirrhosis with ascities . There were 52 (52%) females and 48 
(48%) males. Detailed history was taken from all the patients. The diagnostic criteria were the presence of sign and 
symptoms of chronic liver insufficiency e.g pallor, jaundice, clubbing, palmar erythema, gynecomastia, spider navie, 
visible veins, splenomegaly, edema or ascities etc. Laboratory investigations include CBC, LFTs, PT, total protein, 
Ascitic fluid D/R etc. and specific investigations especially ultrasound of abdomen as diagnostic modality and for 
assessment of cirrhotic patients with ascities.  
Results: All patients fulfilling the inclusion criteria. Age ranging from a minimum of 20 years to 80 years with 
mean ages of patients was 44.99 ± 14.29 years. There were 52 (52%) females and 48 (48%) males. Twenty one 
(21%) patients positive for spontaneous bacterial peritonitis because of WBC ≥500 and neutrophils ≥ 250 /mm³ 
while 79 (79%) patients who had WBC ≤ 500 and neutrophils < 250 /mm³ were spontaneous bacterial peritonitis 
negative. SBP positive, 8 (38 %) were females and 13 (62 %) males. Average systolic and diastolic blood pressure 
was found 110 ± 9.32 mmHg  and 80 ± 62.98 mmHg, mean pulse rate 83.30 ± 5.81 /min, mean hemoglobin 9.14 ± 
1.89 g/dL, total leucocytes count 6408.85 ± 2333.69 /mm, platelets 191.32 ± 54.59 x109/L, total biluribin 1.99 ± 
1.33 mg/dL, total proteins 5.96 ± 0.46, SGPT 134.53 ± 267.06 Unit/L, alkaline phosphatase 314.34 ± 200.85 Unit/L, 
ascitic fluid proteins 1.35 ± 0.83g/dL, ascitic fluid neutrophils 282.58 ± 48.73/mm, ascitic fluid lymphocytes 43.09 ± 
19.38/uL,  ascitic fluid RBC 1465.25 ± 2653.35/uL and average duration of stay in hospital was 8.23 ± 4.4. 
Conclusion: In this study clearly showed a high percentage of asymptomatic SBP in cirrhotic patients with ascities. 
This is quite high in comparison with national and international studies. Thus in future studies should be conducted 
determining the factors associated with high frequency.