 |  Fever and abdominal pain
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| Author | 13 Posts |
usmlejedi
Forum Newbie
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A 53-year-old man is admitted to the hospital for fever and abdominal pain. He has a history of cirrhosis and is known to be hepatitis C positive. He was diagnosed with cirrhosis four years ago. He denies any alcohol or tobacco use. His only medications are spironolactone and propranolol. He reports that five days ago, he had fever to 102 degrees F and the gradual onset of diffuse abdominal pain. On examination, his temperature is 38.3 C (101 F), his blood pressure is 100/50 mm Hg, and his pulse is 110/min and regular. His lungs are clear, he has numerous spider angiomata on his thorax and back, and his abdomen is massively distended, with shifting dullness by percussion. Laboratory studies show: Leukocytes..............13,200/mm3
Hematocrit..............33%
Prothrombin time.....15.2 seconds
Albumin..................0.1 g/dL
Sodium...................135 mEq/L
Potassium...............4.7 mEq/L
Which of the following is the most appropriate next step in diagnosis?
A. Abdominal ultrasound
B. Abdominal CT scan
C. Electrocardiogram
D. Abdominal paracentesis
E. Lumbar puncture
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| sukhs
Forum Senior
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Abdominal Paracentesis because we will like to culture the fluid and see for the organisms and antibiotic senstivity for this likely case of spontaneous bacterial peritonitis.........
hope i am right...
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| Justice
Forum Fanatic
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D. Abdominal paracentesis
this matter is always confusing to me. Kaplan notes say that the treatment is Antibiotics but does not mention if we need to evacuate the infected fluid. Usually this is due to E. Coli so empricic Abs are appropriate untill we have the culture resulsts. StepUp says that repeated paracentesis is recommended to see reduction in number of PMNs and bacteria, but again, why wouldn't we evacuate all the fluid + give albumin to control oncotic/hydrostatic pressure along with giving antibiotics
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| SkiKidd
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We don't due a paracentesis to evacuate any of the fluid and we arent going to wait for the culture to come back. We want to do a gram stain (not for bacteria b/c the yield is low) we want to see WBCs > 500 and neutrophils >250. This indicates infection and lets us empirically treat with a cephalosporin until the cultures come back.
We don't give albumin b/c we'd have to give albumin forever, there is really nothing we can do about the low albumin level. The best we can do is treat with spirinolactone.
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| liliaeliz
Forum Elite
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d
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| elitoki
Forum Guru
Topics: 54
Posts: 508
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leukocytosis and fever in cirrhotic pte, I think we should suspect on bacterial peritonitis.
Abd. paracentesis will help to dx and iniciate ab treatment.
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| usmlejedi
Forum Newbie
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Are you sure?
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| Justice
Forum Fanatic
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usmlejedi wrote:
Are you sure?
What is correct answer, colleague?
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| starcraftbw
Forum Senior
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^^^D ......do you change your management with abd U/S or CT? soon or later you have to tab the fluid out
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| Dr.D
Forum Senior
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Posts: 191
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Answer is D
usmlejedi, What is the right answer?
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| Kamsi
Forum Guru
Topics: 103
Posts: 347
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E
pt has spontaneous bact peritonitis, Paracentesis is for gram stain of the fluid afterwhich U start antibiotics
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| Kamsi
Forum Guru
Topics: 103
Posts: 347
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Sorry meant to write D
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| anjushree
Forum Guru
Topics: 64
Posts: 386
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do paracentesis---WBC >500,PMN >250
sent culture,but not wait for it ---usually E.coli or Pneumococci
start antibiotics--choice is iv cefotaxime
to prevent recurrence---give cipro or norflox
albumin decrease mortality
for high risk cirrhotic (ascitic protein <1 g/dl)----prophylactic dose of norfloxacin
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