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Spontaneous Bacterial Peritonitis (SBP) is a serious and dangerous complication of cirrhosis with portal hypertension. Prompt diagnosis mandates paracentesis with appropriate handling and evaluation of ascitic fluid obtained. A 37-year-old female with cirrhosis and portal hypertension, with a history of SBP, presented with abdominal pain and encephalopathy. With medical management, the encephalopathy cleared and the patient was able to return home. The presented clinical scenario provides valuable teaching insight into the need to appropriately evaluate such a patient with the mandate to diagnose spontaneous peritonitis promptly. Timely evaluation and appropriate management offers clinicians an opportunity to reduce morbidity and mortality in patients with advanced liver disease.