The EM Educator Series: Spontaneous Bacterial Peritonitis

Author: Alex Koyfman, MD (@EMHighAK) // Reviewed by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case 1:

A 55-year-old male with a history of cirrhosis and recurrent ascites presents with worsening abdominal pain and distension. He also states he has had a subjective fever with chills. Exam reveals mild, diffuse abdominal tenderness and positive fluid wave. He otherwise appears well.

Case 2:

A 57-year-old female presents with a week of abdominal pain and swelling. The pain worsened the initial 2 days but then improved. However, the pain returned and is more severe.  The patient has also experienced chills, rigors, and fevers the last 2 days.  Exam reveals BP 108/55, HR 122, RR 23, T 38.2 C, and severe abdominal tenderness with palpation. Bedside US reveals evidence of fluid with septations and free air.



  • What are the types of bacterial peritonitis?
  • How can patients with bacterial peritonitis present?  How do the different types differ in their presentation?
  • What laboratory testing is recommended, and what should you expect to find?
  • When and what type of imaging should be obtained?
  • What is the management of SBP? Who should receive albumin?


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