Friday, July 27, 2007

Answer: VizD Image Challenge Week of 7/23/2007

Congratulations to John Haughey - he is the first person to submit the correct answer to this week's VizD. Thank you to everybody who participated, there were many correct submissions but I can only pay one person a week!


To view John's answer, click here

John Haughey is the winner of $5.

To view John's blog, Journal of a Gypsy Doctor, click here

Recap:

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)
Questions:
1. What is the presumed clinical diagnosis?
2.
What is the diagnostic criteria of this condition?
3. What is the treatment of this condition?




Answers:
1.
Spontaneous bacterial peritonitis
2. A positive ascitic fluid bacterial culture and an elevated ascitic fluid polymorphonuclear (PMN) count > 250 cells/ml
3. Cefotaxime or similar (3rd generation cephalosporin)





More on the management SBP can be found in the article titled:
Management of Adult Patients with Ascities Due to Cirrhosis. Hepatology, March 2004


The next VizD will be posted on Monday July 30.

VizD 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.

3 comments:

Adam said...

John,
Please email me at nyemergencymedicine@gmail.com to receive your $5 prize.

Congratulations!

Charles Maltz said...

Tow comments:

1)In the cirrhotic with elevated bilirubin or creatinine IV albumin may be helpful in addition to antibiotics to prevent the development of hepatorenal syndrome.

2) Use of the urine dipstick can show the presence of wbc and allow the instituting of antibiotic therapy before the cell count is back from the lab.

NocturnalRN said...

I love your blog! Am blog rolling you and need to read ALL posts. Cool