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SBP After Variceal Banding — RACP Adult Medicine MCQ

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ModerateGastroenterologySBP After Variceal BandingRACP Adult Medicine

A 55-year-old man with cirrhosis has a variceal band ligation 3 days ago. He now presents with fever (39°C), abdominal pain, and confusion. Ascitic fluid: PMN 850 cells/μL. Blood cultures grow E. coli. He is on norfloxacin prophylaxis. What is the most likely precipitant of his decompensation?

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Correct answer: A — Spontaneous bacterial peritonitis

SBP (PMN ≥250/μL) precipitated by bacteraemia after variceal band ligation (mucosal breach → bacterial translocation) in a cirrhotic patient on quinolone prophylaxis (E. coli — may be quinolone-resistant). Treatment: IV ceftriaxone (not norfloxacin — inadequate for active SBP) + IV albumin (1.5 g/kg day 1, 1 g/kg day 3). SBP is one of the most common precipitants of hepatic decompensation and HE.

Reference: GESA – 2024 – SBP; EASL 2024