A middle aged patient with chronic liver disease presents with pain abdomen and distension. He also has diarrhoea and fever since one day. On examination, he is hemodynamically stable with fever of 100 oF. There is jaundice, pallor, pedal edema and ascites. A diagnostic paracentesis is done. Ascitic fluid protein is 0.8 gm%, sugar 100 mg%, total count 500/mm3 of which 85% are polymorphonuclear leaukocytes and 15% lymphocytes. Most likely diagnosis is:
(a) Spontaneous bacterial peritonitis
(b) Secondary bacterial peritonitis
(c) Perforation peritonitis
(d) T B peritonitis
ANS- (a) Spontaneous bacterial peritonitis
Spontaneous bacterial peritonitis (SBP) may present with abdominal pain, rebound tenderness, absent bowel sounds and fever in a patient with obvious features of cirrhosis and ascites.
Abdominal signs are mild or absent in about one-third of patients, and in these individuals hepatic encephalopathy and fever are the main features.
Diagnostic paracentesis may show cloudy fluid, and an ascites neutrophil count of > 250 × 106/L almost invariably
The source of infection cannot usually be determined, but most organisms isolated are of enteric origin and Escherichia coli is the most frequently found.