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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Recognize the clinical manifestations of spontaneous bacterial peritonitis (SBP; also known as primary bacterial peritonitis).

  • List the goals of antimicrobial therapy for SBP.

  • Recommend appropriate therapy for SBP.

  • Monitor therapy for SBP for safety and efficacy.

  • Recommend secondary prophylaxis for SBP.

PATIENT PRESENTATION

Chief Complaint

“My belly hurts so bad I can barely move.”

HPI

John Chavez is a 47-year-old Hispanic man who was brought to the ED by his wife. She stated that he has been suffering from nausea, vomiting, and severe abdominal pain for the past 2–3 days. His intake of food and fluids has been minimal over the past several days.

PMH

Cirrhosis, diagnosed last year with onset of ascites

Cholecystectomy 15 years ago

FH

Mother was alcoholic; died 10 years ago in car accident. Father’s history unknown.

SH

Retired construction worker; EtOH abuse with 10–12 cans of beer per day × 25 years and occasional heavier use on weekends; denies use of tobacco or illicit drugs; inconsistent adherence to medications; per patient’s wife he avoids salt but confirms he eats fast food two to three times per week

Meds

Furosemide 40 mg PO once daily

Acetaminophen 325 mg PO PRN for pain

All

NKDA

ROS

As noted in the HPI. Denies any hematemesis or melena.

Physical Examination

Gen

Thin man who appears older than his stated age, with a distended abdomen and in severe pain

VS

BP 154/82, P 102, RR 32, T 38.2°C; current Wt 92 kg, (IBW 68 kg)

Skin

Jaundiced, warm, coarse, and very dry. Spider angiomata present on chest, back and arms.

HEENT

Yellow sclera; PERRLA; Oropharynges show poor dentition but are otherwise unremarkable.

Neck/Lymph Nodes

Supple; normal-size thyroid; no JVD or palpable lymph nodes

Chest

Lungs are CTA; shallow and frequent breathing

Heart

Tachycardia, normal S1 and S2 with no S3 or S4

Abd

Distended; pain on pressure or movements; pain is sharp and diffuses throughout abdomen; (+) ...

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