A 50-year-old male with decompensated alcoholic cirrhosis presents with worsening abdominal distension, fever (38.4 C), and diffuse abdominal tenderness. Diagnostic paracentesis yields cloudy ascitic fluid. Ascitic fluid analysis reveals an absolute neutrophil count (ANC) of 420 cells/mm3. What is the definitive diagnosis, and what is the immediate treatment of choice?

Answer and explanation

Correct answer: D. Spontaneous Bacterial Peritonitis (SBP); Intravenous third-generation cephalosporin (Cefotaxime)

  1. Step 1: Spontaneous Bacterial Peritonitis (SBP) is defined by an ascitic fluid polymorphonuclear (PMN / neutrophil) count >= 250 cells/mm3 in the absence of an identifiable intra-abdominal surgical source.
  2. Step 2: Empiric intravenous broad-spectrum antibiotic therapy with a third-generation cephalosporin (e.g., Cefotaxime or Ceftriaxone) along with intravenous albumin is the standard life-saving therapy.
Answer
Spontaneous Bacterial Peritonitis (SBP); Intravenous third-generation cephalosporin (Cefotaxime).
Why not the others: 'Tuberculous peritonitis' is characterized by lymphocyte-predominant fluid with elevated adenosine deaminase (ADA) and positive acid-fast staining; 'Secondary bacterial peritonitis' features PMN count in thousands, multiple organisms on Gram stain, and very low glucose/high protein; 'Chylous ascites' is milky fluid with high triglyceride content (> 200 mg/dL).

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