kashdoc21
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1. A 70-year-old woman has had increasing abdominal pain over the past 2 days. She has renal failure and has been receiving peritoneal dialysis for 18 months; her last treatment was 2 hours ago. She appears toxic. Her temperature is 39 C (102.2 F), and blood pressure is 140/90 mm Hg. Her abdomen is distended and diffusely tender to deep palpation with rebound tenderness. Leukocyte count is 18,000/mm3. Which of the following is the most appropriate next step?
A ) X-ray films of the abdomen
B ) Comparison of abdominal fluid amylase with serum amylase activity
C ) Gram's stain of abdominal fluid
D ) Ultrasonography of the abdomen
E ) CT scan of the abdomen and pelvis
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| Ujk
Forum Elite
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A ) X-ray films of the abdomen
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| cool doctor
Forum Junior
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I think this is peritonitis
so among the options I think its C
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| Ivonne
Going for step 3/99
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Spontaneous bacterial peritonitis
peritoneal fluid exam--------->if PMN >500 is 86% sensitive for SBP(Not sure how sensitive is gram stain) but i will go with C
If patient doesn't improve with antibiotics in 24 hours then more studies
Nice question
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| arlete
Intern in 2009!!!!!
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C
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| multifactorial
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C
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| neuroblastoma
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 c
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| sprint123
Forum Guru
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Doesn't SBP occurs only in patients who have ascites already? Is SBP in this patient is due to the fluid collection due to renal failure which was already present?
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| Korotkoff
Forum Senior
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Isn't peritonitis one of the complications of peritoneal dialysis? Who is giving those downloadable versions of answers? Horrible!
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| drduck
Forum Guru
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if this is really from NBME question bank, its not good,
will be better if u post it as NBME Q.......next time.
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| guangyu
Forum Elite
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I think the answer is D. The question did not mention patient have ascite already, and may be the patient have air in belly, so if i am facing this patient, i will so ultrosone instead of centesis.
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| DrS
Forum Elite
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The diagnosis is probably peritonitits secondary to peritoneal dialysis. I dont think this is called SBP as in SBP by definition there is no obvious focus of infection. Since peritonitis is the most likely diagnosis the logical answer would seem to be C. An ultrasound whether it shows fluid or not is not going to alter the management and it might not show small amounts of intrabdominal air of fluid. I suppose if youre thinking about a perforated viscus an erect CXR might be a better option but since the most likely diagnosis is a peritonitis I would go for C
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| sherry39
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aaaa
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| Markus2009
Forum Senior
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I think it is peritonitis in a patient on CAPD (continuous ambulatory peritoneal dialysis) that is usually due to gram + pathogens. Next step would be to take a sample of peritoneal dialysis fluid, analyze cellularity, gram stain and start empiric antibiotics such as vancomycin.
C
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