A 70-year-old woman has had increasing abdominal p - behcet

[ArchivalUser]

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

[ArchivalUser]

c....it's this a nbme q ????

[ArchivalUser]

D Ultrasonography of the abdomen.

[ArchivalUser]

Answer D

[ArchivalUser]

peritonitis. one of complication of dialysis..... is it ??

[ArchivalUser]

Yes it is an NBME q. In my answer key E is the answer. But why? What are we trying to find c CT scan or U/S
My answer is C

[ArchivalUser]

cant it be acute pancreatitis caused by dialysis,so reqire ct eval

[ArchivalUser]

you cannot get rebound tenderness in Pancreatitis, b/c it is a retroperitoneal organ. Bacterial peritonitis incidence in P. dialisis pt is high.

[ArchivalUser]

makes sense................