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Spontaneous Bacterial Peritonitis — RACP Adult Medicine MCQ

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EasyGastroenterologySpontaneous Bacterial PeritonitisRACP Adult Medicine

A 60-year-old man with cirrhosis and ascites presents with fever and abdominal pain. Ascitic fluid: WCC 850 cells/μL (80% PMNs), protein 12 g/L, culture pending. SAAG 16 g/L. What is the most likely diagnosis?

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Correct answer: E — Spontaneous bacterial peritonitis

PMN count ≥250 cells/μL in ascitic fluid is diagnostic of SBP regardless of culture result (culture-negative SBP is common). Treatment: IV ceftriaxone (or cefotaxime) for 5 days plus IV albumin (1.5 g/kg on day 1, 1 g/kg on day 3 — reduces renal failure and mortality). Secondary prophylaxis with norfloxacin daily reduces recurrence.

Reference: GESA – 2024 – SBP; EASL 2024 Decompensated Cirrhosis