Spontaneous bacterial peritonitis is an important consideration for any hospitalized patient with substantial ascites. Patients can have minimal symptoms. To complicate matters further, in some cases spontaneous bacterial peritonitis may present with failure of other organs (e.g. hepatic encephalopathy, or disseminated intravascular coagulation leading to gastrointestinal hemorrhage).
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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Great job as usual. I sometime skip paracentesis and treat patient empirically. Have seen patient with hemoperitoneum post paracentesis. If I have someone on broad spectrum antibiotic and no peritoneal sign. I usually skip doing paracentesis to avoid procedure related complication and also if my US doesn’t show loculated ascites.
Having said that if they don’t get better in 48 hour will do ct and possible para at that time.
What do you think ?