Key Points
- Confirm diagnosis early with highest-yield tests (e.g., MRV for CVST, CTA for mesenteric ischemia).
- Dose-and-route precision for high-risk medications; monitor for adverse effects.
- Explicit ICU criteria and consultation triggers.
Clinical Synopsis & Reasoning
Suspect SBP in cirrhosis with ascites and abdominal pain or encephalopathy. Diagnose via ascitic PMN ≥250/µL; start empiric third-generation cephalosporin and give albumin to reduce renal failure in high-risk cases.
Treatment Strategy & Disposition
Stabilize airway/breathing/circulation; initiate guideline-concordant first-line therapy; tailor escalation or de-escalation to clinical response and objective metrics; define clear disposition criteria (e.g., ICU triggers, ward acceptability, outpatient safety).
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitating factors
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC | Anemia/leukocytosis | Context-specific | Trend with therapy |
| BMP | Electrolytes/renal | Derangements common | Renal dosing |
| Condition-specific imaging | See topic | Diagnostic hallmark | Do not delay when red flags present |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Cefotaxime / Ceftriaxone | 3rd-gen cephalosporin | Hours | Empiric therapy | Adjust for local resistance |
| Albumin (1.5 g/kg day 1; 1 g/kg day 3) | Colloid | Hours | Prevents HRS/renal failure in high risk | Volume overload risk |
| Norfloxacin / Ciprofloxacin | Fluoroquinolone | Hours | Secondary prophylaxis | Resistance, tendinopathy |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy
Patient Education / Counseling
- Explain red flags, adherence, and follow-up plan
References
- Authoritative guideline/review; see internal bibliography — Link