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+--- Thread: GI question - berserk (/showthread.php?tid=529101)
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GI question - berserk - ArchivalUser - 08-30-2010
A 45-year-old Hispanic male migrant worker has a 2-month history of increasing abdominal girth, intermittent fever, and weakness. Medical history is unremarkable. The patient does not believe that he has ever had hepatitis. He drinks one or two glasses of wine weekly, takes no medications, and denies use of illicit drugs. His
weight has increased by about 7 kg (15 lb) over the past 2 months. On physical examination, he appears chronically ill. Temperature is 38.5 °C (101.3 °F), pulse rate is 104/min, respiration rate is 26/min, and blood pressure is 110/65 mm Hg. There are no stigmata of chronic liver disease. Abdominal examination reveals distention and shifting dullness without organomegaly.
Laboratory Studies
Hematocrit 38%
Leukocyte count 12,400/μL (with 46% lymphocytes, 16%monocytes, and 35% neutrophils)
Platelet count 225,000/μL
INR 1.0
Activated partialthromboplastin timeNormal
Blood urea nitrogen 26 mg/dL
Serum creatinine 1.5 mg/dL
Serum electrolytes Normal
Serum aspartate aminotransferase35 U/L
Serum alanineaminotransferase37 U/L
Serum total protein 6.5 g/dLm Serum albumin 3.6 g/Dl . Paracentesis reveals clear fluid that contains 350 cells/μL (90% mononuclear cells), total protein of 3.2 g/dL, and albumin of 2.8 g/dL. Cultures of ascitic fluid are negative at 48 hours. Which of the following is the most appropriate management at this time?
( A ) Administration of furosemide and spironolactone
( B ) Administration of metronidazole
( C ) Skin tests for tuberculosis and fungal diseases
( D ) Diagnostic laparoscopy with biopsy and culture of peritoneal tissue
( E ) Liver biopsy for tissue culture and histologic studies
0 - ArchivalUser - 08-30-2010
I think its D...
0 - ArchivalUser - 08-30-2010
bump
0 - ArchivalUser - 08-30-2010
aaa
0 - ArchivalUser - 08-30-2010
-c-
0 - ArchivalUser - 08-30-2010
D...
0 - ArchivalUser - 08-30-2010
if it was transudate, then choice A will be my choice.
but since SAAG is < 1.1, then it is exudate, so the possiblity it is TB, to diagnose TB peritonitis can be done by choosing D.
my choice is D.
this is a good question for discussion, do we have an answer for this ques
0 - ArchivalUser - 08-30-2010
C..... cuz i think laproscopy is not option if there is ascites
0 - ArchivalUser - 08-30-2010
u dont wanna do skin testing for diagnosis, yes u can do lapro for ascites
0 - ArchivalUser - 08-30-2010
sami....man...thats y i look upto u..i was thinkin on tubercular terms...too....