title: Abdominal tenderness in ascites patients indicates spontaneous bacterial peritonitis.
abstract: 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.
authors.affiliation: Department of Medicine, Sahlgrenska University Hospital/Ostra, SE-416 85, Göteborg, Sweden.
authors.forename: Sven
authors.initials: S
authors.lastname: Wallerstedt
authors.forename: Rolf
authors.initials: R
authors.lastname: Olsson
authors.forename: Magnus
authors.initials: M
authors.lastname: Simrén
authors.forename: Ulrika
authors.initials: U
authors.lastname: Broomé
authors.forename: Staffan
authors.initials: S
authors.lastname: Wahlin
authors.forename: Lars
authors.initials: L
authors.lastname: Lööf
authors.forename: Rolf
authors.initials: R
authors.lastname: Hultcrantz
authors.forename: Klas
authors.initials: K
authors.lastname: Sjöberg
authors.forename: Hanna Sandberg
authors.initials: HS
authors.lastname: Gertzén
authors.forename: Hanne
authors.initials: H
authors.lastname: Prytz
authors.forename: Sven
authors.initials: S
authors.lastname: Almer