Peritonitis bacteriana espontánea en pacientes con cirrosis mayores de 65 años

Rodríguez, B Merino; Martínez, Óscar Núñez; Sánchez, Ana M.; Peña, Ana Matilla; Ricote, Gerardo Clemente

doi:10.1016/j.medcli.2008.12.035

Cited by 2 publications

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References 18 publications

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“…La vida media en la cirrosis descompensada es de 2 años 25 . Cuando las complicaciones aparecen, como es el caso de la hemorragia digestiva, la mortalidad puede alcanzar tasas hasta del 70% en los casos refractarios o en los que no se logra cohibir 26 , o bien en relación a la presencia de peritonitis bacteriana espontánea en el paciente con ascitis, donde puede alcanzar una mortalidad intrahospitalaria de 23,3% 27 . Finalmente, la vida media de los pacientes con cirrosis en los que aparece la ascitis es de 2 años 28 .…”

Section: Introducción Y Objetivosunclassified

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Main causes and factors associated with liver cirrhosis in patients in the General Hospital of Zone 2 of Chiapas, Mexico

González¹,

González²

2012

Medwave

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Background: Liver cirrhosis is a worldwide public health problem. Its main characteristic is low life expectancy. In Mexico, it is the second leading cause of death in the age group with the highest work productivity. Methods: The study is observational, retrospective, descriptive and cross-sectional. Data were collected on age, sex, occupation, origin, risk factors for liver damage and probable etiology of patients referred with a diagnosis of cirrhosis in a period of 2 years. Purpose: To determine the causes and factors associated with liver cirrhosis in our population. Results: Females prevailed over males by 57.2% over 42.7%. Average age was 55.27 and 55.02% were Tuxtla Gutierrez residents. The following risk factors were found: alcohol consumption (74.67%), diabetes mellitus (56.33%), obesity (41.92%), use of alternative medicines (19.22%), frequent use of drugs (12.66%), and transfusion (9.17%). Housewives were most affected (50.21%) [95% CI 43.6-56.9]. Alcoholism in 47.59% was found to be a triggering factor; in 41.92% the cause was unexplained or cryptogenic; and in 5.24% the cause was chronic viral hepatitis. Portal hypertension data were found in 89.5%: 59.8% had esophageal varices, 37.11% had ascites, and 2.62% had chronic hepatic encephalopathy. VP > 11 mm in 18.7%. The prevalence during the study period was 9.85%. Conclusions: There are significant differences observed in gender and cause of cirrhosis in this study. In the future more research should be done to look into the conditions under which women live in the city of Tuxtla Gutierrez, as well as whether other idiosyncratic factors or cultural conditions are leading to a higher prevalence of cirrhosis in this population group in the Southeast of Mexico

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Section: Introducción Y Objetivosunclassified

“…Average age was 55. 27 and 55.02% were Tuxtla Gutierrez residents. The following risk factors were found: alcohol consumption (74.67%), diabetes mellitus (56.33%), obesity (41.92%), use of alternative medicines (19.22%), frequent use of drugs (12.66%), and transfusion (9.17%).…”

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Main causes and factors associated with liver cirrhosis in patients in the General Hospital of Zone 2 of Chiapas, Mexico

González¹,

González²

2012

Medwave

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Secondary and Spontaneous Bacterial Peritonitis in Patients With Liver Cirrhosis and Ascites

Kiprin

2020

AJGH

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Spontaneous bacterial peritonitis (SBP) is the main cause of death in patients with liver cirrhosis. SBP is a disease of the gut -after bacterial translocation of monomicrobial flora in mesenteric lymph nodes, while secondary bacterial peritonitis (SecBP) is due to an intra-abdominal source of infection -perforation or inflammation. Peritonitis in liver cirrhosis is classified as spontaneous, secondary and perforative. The frequency of SBP is ~10% of all hospitalized patients with cirrhosis and ascites, while the frequency of SecBP is ~5%, therefore SecBP reports are few. The treatment of SBP is conducted with drugs, while SecBP is treated preferably surgically. While the mortality from SBP nowadays has decreased from 90% to 20%, in SecBP it remains high (60-80%). There are three clinical forms of SBP -latent (10%), classical and fulminant (5%). The oligosymptomatic clinical form of SBP and the culture-negative neutrophilic ascites (CNNA) are the most common forms of contemporary ongoing SBP. Today SBP can be observed in half of the patients with cirrhosis in class B. Peritonitis in Child-Pugh class A cirrhosis is probably secondary. IAC (International Ascites Club) recommends the SBP diagnosis to be taken in polymorphonuclear leucocytes (PMNs) in ascitic fluid >250/mm3 regardless of the result of bacterial cultures. Leucocytes /and ascitic fluid total protein (AFTP)/ increase in ascitic fluid after diuretic treatment, but not the PMNs. In patients with AFTP<10g/L the risk of SBP increases tenfold /decreased opsonic activity of ascitic fluid/. The ascitic bacterial cultures in SBP are rarely positive. At present, half of the episodes of SBP are caused by gram-positive bacteria. Blood cultures should be performed in all patients with suspected SBP. Bacterioscites (5%) does not need treatment, but monitoring, if there are no clinical symptoms and signs of systemic inflammation or infection. SecBP should be suspected in patients who have localized abdominal symptoms or signs, presence of multiple microorganisms (aerobes and anaerobes) in ascitic culture, very high ascitic neutrophil count and high ascitic total protein concentration. A SecBP should be suspected when at least two of the following features are present in ascitic fluid: glucose levels <50mg/dL, protein concentration >10g/L, lactic dehydrogenase concentration > normal serum levels. Due to the low sensitivity and specificity of these criteria for SecBP, examination of alkaline phosphatase (>225U/L) and carcinoembryonic antigen (>5ng/ml) in ascites are recommended /Runyon's criteria/. Patients with suspected SecBP should undergo CT. Conclusion:The medical and surgical treatment of peritonitis in liver cirrhosis may be almost equally dangerous in wrong diagnosis.

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Peritonitis bacteriana espontánea en pacientes con cirrosis mayores de 65 años

Cited by 2 publications

References 18 publications

Main causes and factors associated with liver cirrhosis in patients in the General Hospital of Zone 2 of Chiapas, Mexico

Main causes and factors associated with liver cirrhosis in patients in the General Hospital of Zone 2 of Chiapas, Mexico

Secondary and Spontaneous Bacterial Peritonitis in Patients With Liver Cirrhosis and Ascites

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