(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: The development of ascites in patients with cirrhosis is very likely to lead to bacterial infection in the abdominal cavity, resulting in bacterial disease, i.e. primary peritonitis. As in this case, the patient presented to the clinic with abdominal distension, abdominal pain, nausea and other discomforts, and an abdominal ultrasound was performed suggesting cirrhotic ascites, which was diagnosed as primary peritonitis with hepatitis B cirrhosis in decompensated stage. After aggressive anti-infection, liver protection, rehydration, albumin supplementation, diuresis and other symptomatic treatments, the patient’s abdominal pain symptoms improved significantly and her vital signs were stable without significant discomfort.
Basic information】Female, 69 years old
Disease Type】Primary peritonitis, hepatitis B cirrhosis decompensated stage
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of Consultation】February 2022
【Treatment plan】Medication (intravenous infusion of cefoperazone sodium sulbactam sodium + glutathione + furosemide + albumin + glucose, oral entecavir)
Treatment period] 9 days in hospital
Treatment effect] The patient’s vital signs were stable, no significant discomfort
I. Initial interview
An elderly woman was wheeled into the consultation room by her family, and we were told that the patient had a 10-year history of hepatitis B cirrhosis, vomiting blood, black stool and ascites. In the past 3 days, he had no obvious cause for abdominal distension, and in the past 2 days, he had fever with a maximum temperature of 39.3°C, abdominal pain, abdominal distension, nausea, vomiting, fatigue, and poor diet. On examination, the patient was found to have spider nevus, abdominal bulge with pressure pain, rebound pain, abdominal muscle tension, positive abdominal mobile turbid sounds, and bilateral lower limb edema. The patient showed signs of peritonitis and was informed that he needed to be hospitalized and that treatment would provide relief. The patient agreed to be hospitalized.
II. Treatment history
After admission, the patient’s vital signs were normal, blood pressure was normal, there was no sign of infectious shock, and the relevant tests were completed. The liver function tests showed hypoproteinemia and mild liver damage, with glutamyl transferase 94.0 U/L (normal value 7-45) and total bilirubin 58.9 umg/L (normal value 1.7-21). The abdominal ultrasound showed diffuse changes in liver parenchyma, splenomegaly, and liquid dark areas in the abdomen, suggesting cirrhotic ascites. The five items of hepatitis B indicated small triple-positive, and the abdominal fluid extraction examination suggested positive.
The patient was diagnosed with primary peritonitis and hepatitis B cirrhosis in decompensated stage. We explained the condition to the family and informed them that the general effect of medication observation was still possible, and the patient and family agreed to the treatment. Cefoperazone sodium sulbactam sodium anti-infective treatment, glutathione liver protection, furosemide diuretic, albumin input, glucose rehydration, and continued oral entecavir antiviral and other comprehensive treatment were given.
III. Treatment effect
After the patient was admitted to the hospital, after standard anti-infection treatment, liver protection, diuresis, albumin supplementation, rehydration and other supportive treatments, the patient’s body temperature was normal on the 3rd day, abdominal pain was relieved, appetite improved, 24-hour urine volume was about 2600mL, the indexes of liver function and blood routine improved on recheck, and no fever appeared. On the 6th day of admission, physical examination showed that the abdomen was soft, without pressure pain and rebound pain. Symptomatic supportive treatment was continued. On day 9, the patient’s vital signs were stable and there was no significant discomfort. On the 9th day of admission, the patient’s vital signs were stable and he was not feeling well. The routine blood count was 4.01×10^9/L, 58.5% neutrophils, C-reactive protein decreased to normal level, and liver function improved. The patient was discharged at 9 days of hospitalization. The patient was advised to strengthen his immunity, prevent colds and continue oral entecavir for antiviral therapy.
IV. Notes
We are glad that the patient’s condition has improved without any obvious discomfort and was successfully discharged from the hospital, but the following points should be noted.
1. Patients are advised to pay attention to daily maintenance after discharge, avoid overexertion and high-intensity physical activities, pay attention to rest and avoid staying up late.
2, diet to avoid eating greasy food, should not eat more food containing protein, you can moderate the amount of protein to avoid inducing hepatic encephalopathy, because low protein can also trigger ascites. Also pay attention to avoid eating dry and hard irritating food to avoid causing bleeding.
3, need to follow medical advice for long-term oral entecavir for antiviral therapy, and regular follow-up at the liver disease clinic or gastroenterology. Also pay attention to the occurrence of complications, such as ascites and gastrointestinal bleeding should promptly go to the hospital.
V. Personal insight
Primary peritonitis is a common complication in patients with cirrhotic ascites, which is an abdominal infection caused by pathogenic bacteria through the intestinal tract, blood and lymphatic vessels. The patient in this case developed ascites with primary peritonitis due to hepatitis B cirrhosis in its decompensated stage. After timely and effective treatment such as antiviral therapy and rehydration, the condition improved significantly.
Therefore, patients suffering from chronic hepatitis B should be reminded to achieve regular follow-up and active antiviral treatment to avoid the development of hepatitis B into cirrhosis and also to reduce the incidence of complications. One should follow medical advice to take long-term oral antiviral drugs to keep the hepatitis B viral load under normal levels. If you experience abdominal distension, abdominal pain and other discomfort, you should seek medical attention promptly to avoid delaying the disease.