Ascites and Spontaneous Bacterial Peritonitis — Viva

Opening (30 s)

"Ascites and Spontaneous Bacterial Peritonitis — give a one-line definition and the single most important immediate risk."

Model: Ascites is the pathological accumulation of fluid in the peritoneal cavity. Cirrhosis causes over 80 percent of cases through portal hypertension, hypoalbuminaemia, splanchnic vasodilation (nitric oxide) and renal sodium and water retention (RAAS and sympathetic activation). The serum-ascites albumin gradient (SAAG) of 1.1 g/dL or more separates portal-hypertensive from non-portal causes.^[1] Spontaneous bacterial peritonitis is a monomicrobial infection of ascitic fluid without an obvious intra-abdominal source, defined by an ascitic PMN count of 250 cells/mm3 or more, treated with cefotaxime 2 g IV every 8 hours for 5 days plus albumin 1.5 g/kg on day 1 and 1 g/kg on day 3.^[3] The immediate risk in a deteriorating cirrhotic with ascites is untreated SBP with renal impairment — the tap decides it.

Station 1 — Pathophysiology (2 min)

Explain the mechanism chain from cause to clinical features and one major complication.

Station 2 — Clinical diagnosis (2 min)

Classic presentation, atypical groups, named bedside signs, and what you examine for red flags.

Red flag cue: Cirrhotic with ascites and fever, abdominal pain, new or worsening encephalopathy, renal dysfunction or unexplained deterioration - spontaneous bacterial peritonitis until proven otherwise; do diagnostic paracentesis immediately, treat if PMN 250 cells/mm3 or more.^[2]

Station 3 — Investigations (2 min)

First-line tests, definitive tests, and any named score with exact components.

Station 4 — Emergency management (3 min)

ABC priorities, first drugs with dose and route, procedures, and when to escalate to ICU/theatre.

Station 5 — Definitive / long-term care (2 min)

Stepwise definitive therapy, monitoring, complications of treatment, follow-up.

Station 6 — Special populations (2 min)

Child / pregnancy / elderly / immunocompromised / renal impairment — what changes.

Station 7 — Evidence & pitfalls (2 min)

Landmark trial or guideline name if standard; three classic exam traps.

Station 8 — Rapid-fire pearls (1 min)

Five high-yield facts a candidate must not forget under time pressure.

Examiner pass criteria

• Speaks in mechanisms and numbers, not vague lists
• Gives at least one exact dose or threshold
• Names escalation criteria
• Avoids dangerous delays (imaging when unstable, etc.)

References4ShowHide

1. [1]Runyon BA, Montano AA, Akriviadis EA, et al. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites Ann Intern Med, 1992.PMID 1616215
2. [2]Koulaouzidis A Diagnosis of spontaneous bacterial peritonitis: an update on leucocyte esterase reagent strips World J Gastroenterol, 2011.PMID 21448413
3. [3]Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis N Engl J Med, 1999.PMID 10432325
4. [4]Runyon BA, McHutchison JG, Antillon MR, et al. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis Gastroenterology, 1991.PMID 2019378