Serum-Ascites Albumin Gradient (SAAG)
I.
SAAG >
1.1 = Portal-hypertension related; 再用AFTP (ascites fluid total protein)來進一步區分：
甲、AFTP
> 2.5
: cardiac ascites
乙、AFTP
< 2.5 : cirrhosis
II.
SAAG < 1.1 = NON-portal
hypertension related: Peritonitis, peritoneal carcinomatosis, pancreatitis,
vasculitis, hypoalbuminemia, Meig’s syndrome
Peritonitis : WBC
> 500/ mm3 or
PMN > 250
mm3
|
Type
|
PMN/mm3
|
Ascites
culture
|
|
|
Sterile
|
<
250
|
(-)
|
不需治療
|
|
NNBA
|
(+)
unimicrobial
|
||
|
SBP
|
>
250
|
Cefotaxime
2 gm q8h *5d
Ceftriaxone
2 gm/day
70%
GNB, 30% GPC
|
|
|
CNNA
|
(-)
|
||
|
Secondary
|
(+)
polymicrobial
|
3rd
cepha + Metronidazole
abscess,
perforated gut
|
|
|
PD-associated
|
>
100
|
(+)
|
Vanco + Gentamicin (IV + PD)
70% GPC, 30% GNB
|
(NNBA: Nonneutrocytic
bacterascites, SBP: Spontaneous bacterial peritonitis, CNNA: Culture-negative
neutrocytic ascites, PD: Peritoneal dialysis)
õ Secondary peritonitis: 通常AFTP >1 , Gluascites <50, LDHascites
>225
õ Prophylaxis of SBP
-
indication: current
GIB(variceal), h/o SBP, AFTP <1
-
Ceftriaxone 1gm (IV) qd *7d or Baktar DS(double
strength) 1# bid or fluoroquinolone?選
? ABX and dosage