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Spontaneous bacterial peritonitis — MCCQE Part 1 MCQ

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HardAbdominal PainSpontaneous bacterial peritonitisMCCQE Part 1

A 55-year-old man with known cirrhosis presents with increasing abdominal distension, fever and mild confusion. He has shifting dullness, temperature 38.2°C and creatinine 145 µmol/L. White blood cell count is 13.8 × 10^9/L. What is the most appropriate investigation?

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Correct answer: D — Diagnostic paracentesis with ascitic fluid cell count and culture

Any hospitalised patient with cirrhosis and ascites plus fever, encephalopathy or renal dysfunction needs urgent diagnostic paracentesis to assess for spontaneous bacterial peritonitis. CT may be helpful later, but it should not delay ascitic fluid testing. Serum ammonia does not diagnose SBP.

Reference: Canadian Association for the Study of the Liver guidance