ROSH Gastrointestinal Practice Exam

What is the most likely diagnosis for a 43-year-old man with alcoholic cirrhosis, fever, abdominal pain, and distended abdomen with asterixis?

1. Appendicitis

2. Cholecystitis

3. Colitis

4. Spontaneous bacterial peritonitis

The correct answer is: Spontaneous bacterial peritonitis

The clinical presentation described aligns closely with spontaneous bacterial peritonitis (SBP). In individuals with alcoholic cirrhosis, fluid accumulation in the abdominal cavity (ascites) creates an environment that is susceptible to infections, particularly from bacteria that may translocate from the intestines into the peritoneal cavity. The symptoms of fever, abdominal pain, and distention are consistent with an infection in the abdominal cavity, while asterixis – a type of tremor typically seen in liver dysfunction – suggests significant metabolic derangement, often associated with liver disease. SBP is a common complication in patients with cirrhosis and is characterized by the development of infection in the ascitic fluid without the presence of an obvious intra-abdominal source of infection. Prompt recognition and treatment of SBP are critical due to its association with significant morbidity and mortality, highlighting the importance of this diagnosis in a cirrhotic patient presenting with these symptoms. Other potential diagnoses, while they involve abdominal pain and fever, do not typically present in the context of advanced liver disease and the presence of significant ascites, making spontaneous bacterial peritonitis the most likely diagnosis in this scenario.