SPONTANEOUS BACTERIAL PERITONITIS IN CIRRHOTIC PATIENTS WITH HEPATIC ENCEPHALOPATHY

ABSTRACT
Objective: To evaluate the spontaneous bacterial peritonitis in cirrhotic patients with hepatic encephalopathy.
Material and Methods: This hospital based descriptive cross sectional study was carried out in Departments of General
ICU (Intensive Care Unit) and Medicine, Lady Reading Hospital Peshawar from August 2012 to February 2013.A total
number of 111 cirrhotic patients having hepatic encephalopathy and ascites were included in this study. Ascitic fluid
analysis was performed in each patient. Cirrhotic patients with hepatic encephalopathy and ascites having age 15 years
and above were selected in the study while patients with hemorrhagic or malignant ascites and peritonitis due to trauma,
surgery or perforation were excluded. All the data was collected using a Performa and analyzed by descriptive statistics.
Results: Among these 111 patients, 60(55%) were males and 51(45%) were females(1.1:1).The age ranged from 25 to
75 years. Mean age was 54 years and the median age was 52.5 years with mode age 50 years. Out of these 111 patients,
spontaneous bacterial peritonitis (SBP) was present in 40 (36%) patients. The ascitic fluid albumin concentration was
low and ascitic fluid mean total leukocyte count was high in SBP patients and reverse was true for NON-SBP patients.
The clinical features of patients with SBP wee diffuse with most common presentation was abdominal pain (78%),
followed by abdominal tenderness (76%), fever (72%), jaundice (58%), hepatic encephalopathy (48%),hypotension
(22%) and few were asymptomatic(10%).Hepatitis B was present in 31(27.9%), hepatitis C in 76(68.5%) and both B
and C was present in 4(3.6%) patients.
Conclusion: It is concluded that cirrhosis liver is a common problem in our country leading to hepatic encephalopathy.
Most episodes of hepatic encephalopathy are due to clinically apparent precipitating factors. SBP is one of such precipitating
factors leading to hepatic encephalopathy. Failure to recognize the precipitating factor