DR Medhat MRCP

Meigs' Syndrome : = Ovarian fibroma + Low SAAG ascitis + RT pleural effusion
Spontaneous bacterial peritonitis (SBP)
- Is a form of peritonitis usually seen in patients with ascites secondary to liver
cirrhosis .
• Causative organism : aerobic G-ve bacteria (E.coli & klebseila are facultative anaerobes
i.e mainly aerobe but can grow in anaerobic conditions ,her they
should be considered aerobes)
• Rout of infection : via blood or intestinal bacterial overgrowth (not perforation).
• Diagnosis:
Paracentesis : neutrophil count > 250 cells/ul + positive C/S in blood C/S bottles.
• Management:
سؤال ttt. I.V Cefotaxim , co-amoxclav Tazocin or ciprofloxacin is the 1 st line of
Patients who have had an episode of SBP should be on prophylactic antibiotics.
• Prognosis :
- Poor prognosis (one year survival rate is 30-50%).
- Alcoholic liver disease is a marker of poor prognosis in SBP.
Hepatocellular carcinoma (HCC) :
Hepatocellular carcinoma
Hepatitis B most common cause worldwide
Hepatitis C most common cause in Europe
- Is the third most common cause of cancer worldwide.
• Risk factors :
1) Liver cirrhosis (the main risk factor whatever its cause except Wilson`s disease).
2) Alpha-1 antitrypsin deficiency.
3) Hereditary Tyrosinosis.
4) Glycogen storage disease.
5) Aflatoxin.
6) Drugs: oral contraceptive pill, anabolic steroids.
7) Porphyria cutanea tarda.
8) Male sex.
9) Diabetes mellitus, metabolic syndrome
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