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Spontaneous bacterial peritonitis — RACP Adult Medicine MCQ

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HardGastroenterology and hepatologySpontaneous bacterial peritonitisRACP Adult Medicine

A 62-year-old woman with cirrhosis and ascites presents with confusion and abdominal discomfort. Ascitic tap shows neutrophils 640 cells/microlitre and culture is pending. There is no perforation on CT and no intra-abdominal abscess. What is the most likely cause?

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Correct answer: C — Bacterial translocation across the gut wall in decompensated cirrhosis

SBP usually results from bacterial translocation in cirrhosis with ascites, rather than a surgically treatable intra-abdominal source. Endocarditis, autoimmune peritonitis, pancreatic leak and malignancy can cause abdominal pathology but do not explain classic neutrocytic ascites in decompensated cirrhosis. The key teaching point is that diagnostic paracentesis and early antibiotics should follow suspicion.

Reference: Therapeutic Guidelines (eTG) Antibiotic; GESA cirrhosis guidance