A 60-year-old male with cirrhosis and ascites presents with diffuse abdominal pain, fever, and mild confusion. Paracentesis demonstrates cloudy fluid with an absolute neutrophil count of 380 cells/mm^3. What is the definitive diagnosis and primary therapy?

Answer and explanation

Correct answer: B. Spontaneous bacterial peritonitis (SBP); initiate IV cefotaxime

  1. Step 1: An ascitic fluid polymorphonuclear (PMN) count >= 250 cells/mm^3 establishes the diagnosis of spontaneous bacterial peritonitis.
  2. Step 2: Empiric antibiotic therapy with a third-generation cephalosporin (such as IV cefotaxime or ceftriaxone) should be initiated immediately along with IV albumin.
Answer
Spontaneous bacterial peritonitis (SBP); initiate IV cefotaxime.
Why not the others: 'Secondary peritonitis from perforated viscus; urgent exploratory laparotomy' typically shows multiple organisms, very high protein (> 10 g/L), and low glucose; 'Tuberculous peritonitis' presents with lymphocytic predominance and elevated ADA; 'Malignant peritoneal ascites' shows positive cytology.

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