Abdominal tenderness in ascites patients indicates spontaneous bacterial peritonitis.
BACKGROUND
Spontaneous bacterial peritonitis (SBP), which has been reported to be present in 10-30% of patients with cirrhotic ascites, may easily be overlooked. An important aim of our study was to determine whether there are any clinical signs which, in clinical practice, may predict or exclude SBP.


METHODS
We studied 133 patients with cirrhotic ascites from medical units at nine Swedish university hospitals where there had been at least one diagnostic ascites tap with analysis of polymorphonuclear leukocytes in the ascites fluid. The patients had initially been questioned about background factors and physically examined according to a standardized case record form. Samples of blood, urine, and ascites were then drawn for analysis according to a structured schedule.


RESULTS
SBP could be excluded in 80% of all the cases and was confirmed in 8% of the 133 patients in the final analysis. Abdominal pain and abdominal tenderness were more common in patients with SBP (p<0.01), but no other physical sign or laboratory test could separate SBP cases from the others.


CONCLUSIONS
SBP was present in about one-tenth of the hospitalized patients with cirrhotic ascites in this cohort. Performing repeated physical examinations and paying particular attention to abdominal tenderness may be the best way to become aware of the possible development of this complication.
Wallerstedt
Sven
S
Department of Medicine, Sahlgrenska University Hospital/Ostra, SE-416 85, Göteborg, Sweden.
Olsson
Rolf
R
Simrén
Magnus
M
Broomé
Ulrika
U
Wahlin
Staffan
S
Lööf
Lars
L
Hultcrantz
Rolf
R
Sjöberg
Klas
K
Gertzén
Hanna Sandberg
HS
Prytz
Hanne
H
Almer
Sven
S