GASTRO/GENSURG
SPONTANEOUS BACTERIAL PERITONITIS
PromptSBP investigations
ResponseFBC/CRP = raised inflammatory markers ? infection
LFT’s - ? cirrhosis, serum albumin/protein
EUC’s - ? renal impairment as cause for ascites
LDH - for comparison with ascitic LDH
Lipase - ? pancreatitis
Coags - synthetic function, guide procedures
CT - ascites + omental thickening
LFT’s - ? cirrhosis, serum albumin/protein
EUC’s - ? renal impairment as cause for ascites
LDH - for comparison with ascitic LDH
Lipase - ? pancreatitis
Coags - synthetic function, guide procedures
CT - ascites + omental thickening
PromptAscitic fluid investigations (What to order on abdominocentesis sample)
ResponseCell count
TB PCR (apparently must have?)
Cytology
Albumin + total protein
LDH
Gram stain + culture
Glucose
Amylase
bilirubin
TB PCR (apparently must have?)
Cytology
Albumin + total protein
LDH
Gram stain + culture
Glucose
Amylase
bilirubin
PromptSAAG interpretation (Serum ascitic albumin gradient)
ResponseSAAG = [Serum albumin] - [Ascitic fluid albumin]
> 11g/L = high SAAG = transudate (not much protein in fluid so think fluid overload stuff)
Cirrhosis, hepatic failure, hepatic venous occlusion, constrictive pericarditis, Kwashiorkor, cardiac failure, alcoholic hepatitis, liver mets
< 11g/L = low SAAG = exudate (SBP unlikely) (lots of protein in fluid - think pathological stuff)
Malignancy, infection (bacterial, fungal, TB), pancreaitis, nephrotic syndrome, bowel obstruction/infarct, bile leak, vasculitis
WCC >250 = SBP, polymorphs = bacterial, monos = TB
Single bacteria = SBP, Polymicrobial = probably perforated viscous
> 11g/L = high SAAG = transudate (not much protein in fluid so think fluid overload stuff)
Cirrhosis, hepatic failure, hepatic venous occlusion, constrictive pericarditis, Kwashiorkor, cardiac failure, alcoholic hepatitis, liver mets
< 11g/L = low SAAG = exudate (SBP unlikely) (lots of protein in fluid - think pathological stuff)
Malignancy, infection (bacterial, fungal, TB), pancreaitis, nephrotic syndrome, bowel obstruction/infarct, bile leak, vasculitis
WCC >250 = SBP, polymorphs = bacterial, monos = TB
Single bacteria = SBP, Polymicrobial = probably perforated viscous