Monday, July 23, 2007

VizD Challenge Week of 7/23/2007

A 45-year-old man presents to your ED complaining of fever and abdominal pain. He has a history of hepatitis C and ethanol abuse. You perform the procedure seen in the image below to confirm the diagnosis.

(click on image to enlarge)
1. What is the presumed clinical diagnosis?
What is the diagnostic criteria of this condition?
What is the treatment of this condition?

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is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient. For more information please refer to the following link.


Doc Ochieng said...

1. Hepatitis Cirrhoris decompensated vascular
2. You need to perform paracentesis to relief the abdominal pains and disconfort caused by the tense ascites, perform endoscopy to check whether he/she has Varice esophagiene and which grade, perform echography or Computer tomography to check any abnormalities, the fluid collected you need to carry out the following test i.e. LDH, glucose,albumin, protein, cell count and differential. With the fluid collected if the serum-albumin gradient is greater than or equal to 1.1g/dl it means he/she has portal hypertension if less than 1.1 g/dl doesnot have portal hypertension. If ascites fluid PMN greater than 500mcgl then its spontaneous bacterial peritonitis finally if its blood ascitic fluid albumin gradient is less than 1.1. g/dl it indicates malignant ascites.
3. The medications indicated is Spirinolactona 25mg 4tb/day which can be gradually be increased after four days if there is no respond i.e. 8tb/day which can reach maximum dosage 12tb/day inaddition to that is furosemid 40mg 1 tb/day which can be increased gradually maximum 4tb/day. Propranolol 1/2tbx2/day, ciprofloxacina 500mgx2/day

John Haughey said...

Spontaneous bacterial peritonitis. Diagnostic criteria include positive cultures (with 10 mL inoculum), an ascitic neutrophil count greater than 250 cells per mL, and the absence of other surgical source of infection.

Other indices include lactate greater than 25mg/dL in the ascitic fluid, and an ascitic pH of <7.35 plus greater than 250 neutrophils/mL.

Treatment is traditionally ampicillin plus aminoglycoside, although other less nephrotoxic options include cefotaxime or oral ofloxacin. a 2001 Cochrane review by Soares -Weiser suggested there is no evidence to support any of these strategies.