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Spontaneous bacterial peritonitis — SCE Acute Medicine MCQ

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ModerateSepsis and Infectious EmergenciesSpontaneous bacterial peritonitisSCE Acute Medicine

A 58-year-old man is assessed on the acute medical unit. He has cirrhosis, tense ascites, fever and mild confusion. Abdomen is diffusely tender without guarding. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: E — Diagnostic ascitic tap for cell count and culture

Diagnostic ascitic tap for cell count and culture is the best answer because diagnostic paracentesis is essential to identify SBP and should be performed promptly in hospitalised cirrhosis with fever. Urinalysis and urine culture is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Ascitic neutrophil count drives the diagnosis.

Reference: BSG cirrhosis guideline