Monday, August 16, 2010


This gentleman with longstanding hepatitis C, hypertension, and diabetes presents with a temperature of 100.4 F (38 C) and mild abdominal tenderness. His wife says that he's been a little confused lately. Labs show a leukocytosis, azotemia, albumin of 2. You put in a needle and take out fluid from the belly. These fluid studies show:
Albumin 0.2
Total protein 0.5
Glucose 80
WBC 600
RBC 2500
45 % neutrophils
40% lymphocytes
15% monocytes

Challenge: What's your diagnosis?

Image shown under Fair Use.


Suheil said...

Spontaneous bacterial peritonitis.... due to cirrhosis of liver because of the long standing hepatitis c infection. The criteria for diagnosing SBP is ascitic neutrophil count of >250/mm3( in this case it is 270).Treatment is with intravenous antibiotics... The patient is confused due to hepatic encephalopathy....

jbwpac said...


jbwpac said...

ascites, consider checking ammonia level

arif said...

suggestive of spontaneous bacterial peritonitis with encephaloapthy. he has underlying hepatitis c cihhosis of liver

Craig Chen said...

yes - you are all right - it is ascites, but more specifically, spontaneous bacterial peritonitis.

Spontaneous bacterial peritonitis (SBP) is an ascitic fluid infection without any obvious source, seen in patients with advanced cirrhosis. This diagnosis is made with a positive bacterial ascitic culture or an absolute PMN count of >250 cells/mm3. Here, PMNs = WBC * %neutrophils = 270. Then subtract 1 PMN for every 250 of RBC (so here, our value is 260). Also, the SAAG (serum albumin ascites gradient) is >1.1, consistent with cirrhosis. In SBP as compared to secondary bacterial peritonitis, total protein is <1g/dL and glucose is >50.

Sources: UpToDate;