Spontaneous bacterial peritonitis pathophysiology: Difference between revisions

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{{Spontaneous bacterial peritonitis}}
{{Spontaneous bacterial peritonitis}}
{{CMG}}; {{AE}} {{SCh}}  
{{CMG}}; {{AE}} {{SCh}} {{AY}}
 
==Overview==
==Overview==
[[Bacterial overgrowth|Intestinal bacterial overgrowth]] in [[Cirrhosis|cirrhotic]] patients, defective intestinal barrier and defective [[Immune response|host immune response]] are the 3 determinant factors for [[Bacterial|bacterial translocation]] explaining SBP.
[[Bacterial overgrowth|Intestinal bacterial overgrowth]] in [[Cirrhosis|cirrhotic]] patients, defective intestinal barrier and defective [[Immune response|host immune response]] are the 3 determinant factors for [[Bacterial|bacterial translocation]] explaining SBP.
==Pathogenesis==
==Pathogenesis==
Three factors play a role in the pathogenesis of SBP:
Three factors play a role in the pathogenesis of SBP:
* '''[[Bacterial overgrowth]] in [[Cirrhosis|cirrhotic patients]]:''' secondary to [[Motility|decreased intestinal motility]] and frequent use of [[Proton pump inhibitor|PPIs]] in this population of patients.
* '''[[Bacterial overgrowth]] in [[Cirrhosis|cirrhotic patients]]:''' secondary to [[Motility|decreased intestinal motility]] and frequent use of [[Proton pump inhibitor|PPIs]] in this population of patients.
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* '''[[Immunity suppression|Decreased immunity]]:''' both local and systemic immunity are decreased in [[Cirrhosis|cirrhotic patients]].
* '''[[Immunity suppression|Decreased immunity]]:''' both local and systemic immunity are decreased in [[Cirrhosis|cirrhotic patients]].
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===A. Bacterial overgrowth:===
===A. Bacterial overgrowth:===
* [[Motility|Intestinal motility]] decreases with [[cirrhosis]]. Increased [[Sympathetic control|sympathetic drive]] and [[Oxidant|oxidant stress]] are believed to be the reasons for the reduced mobility.  
* [[Motility|Intestinal motility]] decreases with [[cirrhosis]]. Increased [[Sympathetic control|sympathetic drive]] and [[Oxidant|oxidant stress]] are believed to be the reasons for the reduced mobility.  
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* The [[neutrophils]] seem to have declined [[Granulocyte|granulocyte functions]] as adherence, [[chemotaxis]], and bacterial killing.
* The [[neutrophils]] seem to have declined [[Granulocyte|granulocyte functions]] as adherence, [[chemotaxis]], and bacterial killing.


Bacteria that translocates are carried through [[lymphatics]]. It can reach to the [[Ascitic|ascitic fluid]] either through the circulation then through the liver , it can have access to the [[peritoneal cavity]]. Another way is through rupture of the [[lymphatic vessel]] carrying the contaminated lymph under pressure from [[portal hypertension]] and the increased [[lymph]] content.
Bacteria that translocate are carried through [[lymphatics]]. It can reach the [[Ascitic|ascitic fluid]] either through the circulation then through the liver. It can have access to the [[peritoneal cavity]]. Another way is through rupture of the [[lymphatic vessel]] carrying the contaminated lymph under pressure from [[portal hypertension]] and the increased [[lymph]] content.


==References==
==References==
{{reflist|2}}
{{reflist|2}}


{{WH}}
[[Category:Emergency mdicine]]
{{WS}}
[[Category:Disease]]
 
[[Category:Up-To-Date]]
[[Category:Gastroenterology]]
[[Category:Emergency medicine]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]

Latest revision as of 00:15, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2] Ahmed Younes M.B.B.CH [3]

Overview

Intestinal bacterial overgrowth in cirrhotic patients, defective intestinal barrier and defective host immune response are the 3 determinant factors for bacterial translocation explaining SBP.

Pathogenesis

Three factors play a role in the pathogenesis of SBP:

A. Bacterial overgrowth:

B. Increased bowel permeability:

Normally, the intestinal mucosa is impermeable to bacteria because of two lines of defense[2];the secretory component and physical component. Both are affected by the development of cirrhosis.

C. Decreased local and systemic immune responses:

Bacteria that translocate are carried through lymphatics. It can reach the ascitic fluid either through the circulation then through the liver. It can have access to the peritoneal cavity. Another way is through rupture of the lymphatic vessel carrying the contaminated lymph under pressure from portal hypertension and the increased lymph content.

References

  1. Căruntu FA, Benea L (2006). "Spontaneous bacterial peritonitis: pathogenesis, diagnosis, treatment". J Gastrointestin Liver Dis. 15 (1): 51–6. PMID 16680233.
  2. 2.0 2.1 Chang CS, Chen GH, Lien HC, Yeh HZ (1998). "Small intestine dysmotility and bacterial overgrowth in cirrhotic patients with spontaneous bacterial peritonitis". Hepatology. 28 (5): 1187–90. doi:10.1002/hep.510280504. PMID 9794900.