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 54 yr old male complains of  



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Author11 Posts
  #1

54 year old male complains of loss of appetite and weight loss for the past five months. He's noticed a very mild fever which he seems to have most of the time. He's recently immigrated from India, and feels anxious in his new surroundings.
He gives no other history (no hx of abd pain, or change in bowel habits, nausea, vomitting..)
On examination:
PR 90
RR 18
BP 124/80

No tenderness on abdominal palpation; it is of a doughy consistency.

Amongst the Investigations done: an ultrasound/abdomen which shows ascites. Ascitic fluid transcentesis and examination shows:
Total protein > 2.5 g/dL
LDH > 90 U/L
Leucocytosis >500 U/microL
(The patient is H.I.V. negative..)
What is your diagnosis?

A) Depression
B) Metatstatic Malignancy
C) Tuberculous peritonitis
D) Cirrhosis




  #2

HI VARSHA......
SEEN THOUSANDS OF SUCH CASES....

IT'S DEFINITELY A KOCH'S ABDOMEN ....OR TUBERCULOUS PERITONITIS..............

START AKT..........


  #3

AND I WOULD ALSO LIKE TO ADVICE BARIUM FOLLOWUP....AS IS DONE ROUTINELY IN SUCH CASES.....


  #4

i don't understand how can depression cause ascites............


  #5

Yes, it's Tuberculous peritonitis. smiling face
Tuberculosis occurs in extrapulmonary sites in 10% of non-H.I.V. infected people, and in 70% of those who are H.I.V. positive.


  #6

About investigations:
A laparoscopic examination would be diagnostic: nodules would be revealed on the peritoneum; and on biopsy, tuberculous granulomas.


  #7

best non-invasive test for dx of tb peritonitis- ascitic fluid IFN-y and ADA

best screening test for dx of tb peritonitis - ascitic fluid IFN-y and ADA

best confirmatory test for dx of tb peritonitis- laproscopic peritoneal
biobsies with
histopathological
and culture studies


  #8

why can't it be a metastatic malignancy , owing to the cachectic and anorexic context?
what is ADA ( i'm from belgium)
how the biological analysis of aspiration fluid of this man yields the diagnosis ?
regards


  #9

well fabrice,in india if u cannot diagnose tb with this many clues,u ar grossly incompetent.
its not malignancy.doughy abdo is classic tb abdomen.then ada(ADENOSINE DEAMINASE)with 500 lymphocytes plus no malignant cells


  #10

thnak's
how common is TB in India ?


  #11

as common is common cold in usa.......





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