الفهرس 
Spontaneous bacterial peritonitisOnly 14 pages are availabe for public view
 |  | from | 158 |  |  |
| | | from | 158 | | |
Abstract
The objective of the present thesis was to study the association between Model for end stage liver disease and spontaneous bacterial peritonitis.
For this purpose, 100 patients with decompensated liver disease were subjected to the following:-
- Thorough history taking.
- Meticulous clinical examination.
- Full investigations including:
* Complete blood count and ESR.
* Renal function tests.
* Liver profile.
* Serological test for viral markers:-
HBsAg and HCVAb.
* Abdominal ultrasonography.
* Diagnostic abdominal paracentesis: the ascitic fluid was subjected to the following:
- Physical examination.
- Biochemical examination
- Cell count (total and differential leucocytic count).
* Serum- ascites albumin gradient (SAAG).
* Modified Child’s Pugh score and MELD score were done to all patients.
SBP was detected in 26% of the unselected decompensated cirrhotic cases included in this study.
The clinical findings of SBP were extremely variable ranging from asymptomatic to severe illness.
Abdominal pain, abdominal tenderness and fever were the main clinical presentation in SBP patients (73.1%, 73% and 38.5% respectively).
Nausea, vomiting and diarrhea were another presenting symptoms that were also detected in patients with SBP (34.6%, 26.9% and 23.1% respectively). Jaundice had high incidence in SBP patients 80.8%.
Patients with SBP had leucocytosis, increase serum creatinine, serum bilirubin, P.T and INR than non SBP cases.
Regarding ascitic fluid examination, most cases of SBP had turbid ascitic fluid 80.7%. Also increase TLC mainly PMN count and reduced total protein in ascitic fluid than non SBP group.
MELD score of the studied cases revealed that 7.7%, 38.5% and 53.8% of SBP had MELD score < 18, 18 - 27 and > 27 respectively. Moreover, high MELD score was independently associated with high risk of SBP with cut off level of 23.5 with sensitivity 76.9% and specificity 90.5% in prediction of SBP.
SBP should not be excluded in patients with low MELD score as among the studied patients in those with MELD score < 18, two had SBP.