1. Ascites and Spontaneous Bacterial Peritonitis Arthur Harris, MD Attending, Division of Gastroenterology Jacobi Medical Center/North Central Bronx Hospital Assistant Professor of Medicine, AECOM

5. Latest Physiopathology Increased resistance to hepatic flow Portal hypertension Production of splanchnic arterial vasodilators (NO) Early cirrhosis Late cirrhosis

6. Consequences of vasodilatation Decreased effective plasma volume Sodium retentionSodium retention Increased capillary permeability

8. Ascites – Patient Evaluation Assess liver function Evaluation of renal and CVS function Ascitic fluid analysis Endoscopy for varices

12. Therapy It’s all about the sodium

17. Spontaneous Bacterial Peritonitis

23. SBP – Antibiotic Therapy I Initiate for PMN≥250/mm 3 IV Cefotaxime 2g q8 hours or Ceftriaxone 2g q24hours Duration of therapy unclear –2 weeks suggested if Blood cultures(+) –If repeat paracentesis at 48 hours shows PMN≤250/mm 3, then 5-7 days of treatment may be adequate

25. SBP – Antibiotic Therapy II Prophylactic antibiotics should also be prescribed indefinitely until ascites has eliminated Options include: -Bactrim DS 1 tab po 5 days/week -Cipro 750mg po q week