Clinical overview
SBP is infection of ascitic fluid without a surgically treatable source and may present subtly.
Clinical significance
Perform prompt paracentesis, treat when neutrophil threshold is met and consider albumin and secondary prophylaxis according to risk.
Initial assessment
Define symptom onset, physiological stability, bleeding or sepsis risk, nutritional status, medicines, alcohol exposure, previous surgery and relevant family history. Identify alarm features and determine whether urgent endoscopy, imaging, surgical review or liver-centre discussion is required.
Diagnostic strategy
Use targeted laboratory tests, endoscopy, imaging, histology and functional testing according to the clinical question. Interpret results with pre-test probability, disease duration, treatment exposure and test limitations. Repeat or escalate investigation when the result is discordant with the clinical picture.
Management principles
Follow current national and local pathways, treat physiological instability and source-control emergencies first, and define the role of medical, endoscopic, radiological, nutritional and surgical treatment. Document monitoring, safety-netting and specialist follow-up.
Special populations and comorbidity
Pregnancy, frailty, immunosuppression, kidney or liver failure, anticoagulation and previous gastrointestinal surgery may alter presentation and treatment. Children require paediatric pathways and age-appropriate thresholds.
Clinical pearls
- Trend, disease trajectory and objective inflammation often matter more than a single symptom score.
- Do not delay source control or resuscitation while completing routine diagnostic work.
- Nutrition, medicines and cancer risk should be reviewed explicitly in chronic gastrointestinal and liver disease.
Common mistakes
- Reassuring a patient despite alarm features because one screening test is negative.
- Using a score outside its validated population.
- Failing to review anticoagulants, NSAIDs, alcohol or immunosuppression.
- Repeating empirical treatment without reconsidering the diagnosis.
Escalation triggers
Escalate urgently for haemodynamic instability, active gastrointestinal bleeding, peritonism, obstruction, perforation, severe colitis, acute liver failure, encephalopathy, biliary sepsis, rapidly worsening jaundice or concern that endoscopic, surgical, interventional-radiology or transplant-centre treatment may be required.
Related MediCalc clinical tools
Related Clinical References
Frequently asked questions
Can this reference replace a local pathway?
No. Use current local endoscopy, antimicrobial, surgical, hepatology and medicines protocols.
When should investigation be repeated or escalated?
Escalate when alarm features persist, physiology worsens, the first investigation was incomplete or the result does not explain the clinical picture.
Key practice points
- Recognise bleeding, sepsis, obstruction and liver failure early.
- Use objective testing and validated scores appropriately.
- Address nutrition and medicine-related harm.
- Reassess treatment response.
- Provide clear follow-up and surveillance plans.