ROSH Gastrointestinal Practice Exam

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What ascitic fluid neutrophil count is indicative of spontaneous bacterial peritonitis?

Above 100 cells/mcL
Above 250 cells/mcL
Above 300 cells/mcL
Above 500 cells/mcL

The correct answer is: Above 250 cells/mcL

Spontaneous bacterial peritonitis (SBP) is a serious infection that occurs in patients with ascites, particularly in those with cirrhosis. The diagnostic criterion for SBP is primarily based on the neutrophil count in ascitic fluid, as this reflects the inflammatory response to infection. A neutrophil count greater than 250 cells/mcL in ascitic fluid is considered diagnostic for SBP. This threshold is well-supported by clinical guidelines and research studies, which indicate that when the neutrophil count exceeds this level, it is highly indicative of a bacterial infection in the peritoneal cavity. Counts above 250 cells/mcL can lead to clinical symptoms associated with SBP, including abdominal pain, fever, and altered mental status. Prompt identification and treatment of SBP are crucial, as mortality rates can be quite high if left untreated. The other options, while they may indicate inflammation or infection, do not specifically meet the established criterion for diagnosing SBP and therefore are not used as definitive thresholds in clinical practice.