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Spontaneous bacterial peritonitis — ESEGH MCQ

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ModerateHepatologySpontaneous bacterial peritonitisESEGH

A 58-year-old man with alcohol-related cirrhosis is admitted with increasing abdominal distension, fever and new confusion. He is tachycardic, has tense ascites and mild asterixis. Blood tests show bilirubin 62 micromol/L, INR 1.8, creatinine 142 micromol/L and CRP 84 mg/L. Diagnostic ascitic tap shows neutrophils 620/mm3. What is the most appropriate management?

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Correct answer: E — Intravenous cefotaxime with human albumin solution

Ascitic neutrophils above 250/mm3 confirm spontaneous bacterial peritonitis, and treatment should start promptly with a third-generation cephalosporin plus albumin in higher-risk patients to reduce renal impairment. Ciprofloxacin prophylaxis is used after recovery rather than as sole acute therapy. Large-volume paracentesis may help tense ascites, but it does not treat infected ascites. A key pearl is that every unwell patient with cirrhosis and ascites needs early diagnostic paracentesis.

Reference: BSG/BASL Ascites in Cirrhosis Guideline; BASL Decompensated Cirrhosis Care Bundle