q-5 - dr_eas12

[ArchivalUser]

A 38-year-old woman is evaluated because of jaundice and mental confusion. She admits to drinking 1 quart of vodka per day for the last 3 weeks. On physical examination, she has a temperature of 37.8 °C (100.04 °F), with jaundice, spider telangiectasias, a tender and enlarged liver, a protuberant abdomen with a fluid wave, and asterixis. Her hematocrit is 31%, and her leukocyte count is 17,500/μL with 75% polymorphonuclear leukocytes.

Ultrasonography confirms hepatomegaly and ascites. Paracentesis is performed, and ascitic fluid studies show a leukocyte count of 150/µL (80% polymorphonuclear leukocytes) and an albumin level of 1.3 g/dL.

Which of the following is the most likely diagnosis?

( A ) Cholelithiasis
( B ) Alcoholic hepatitis
( C ) Spontaneous bacterial peritonitis
( D ) Pyelonephritis
( E ) Alcohol withdrawal

[ArchivalUser]

_ CCC

[ArchivalUser]

Ans: C....mostly due to Ecoli and in children if it occurs is due Strep Pnumo.

[ArchivalUser]

It looks like C, but leukocyte count of the flud 150/µ (instead of >250)

[ArchivalUser]

SBP IS 250CELLS/mL
HERE IS 150/UL

SO CCCCCCC

which antibiotic is given in this??

[ArchivalUser]

* A history of chronic liver disease and ascites.
* Fever and abdominal pain.
* Peritoneal signs uncommonly encountered on examination.
* Neutrocytic ascites (> 250 white blood cells/mcL) with neutrophilic predominance.


also protein is < 1 gm/dl if it is more than it is againts sbp ( cmdt 2008)

thus it is not sbp

and nothing else fit so i am confused

[ArchivalUser]

( B ) Alcoholic hepatitis

[ArchivalUser]

_ you are right patric3938,

After reviewed the qs, it's not possible for this pt. to have spontanous bacteria peritonitis (Based on fluid wbc and albumin).

so the other choice suppose to be BBBBB > CC

[ArchivalUser]

Right.........BBBBBBBBb
This patient has classic features of acute alcoholic hepatitis: significant alcohol intake, often with acceleration of the amount of intake in the weeks prior to presentation, jaundice, fever, leukocytosis, and a tender, palpable liver. Liver enzyme levels are typically only modestly elevated with an aspartate aminotransferase:alanine aminotransferase (AST:ALT) ratio > 1. Alcoholic hepatitis may resolve spontaneously with abstinence from alcohol, hydration, and nutritional support. All patients who recover from alcoholic hepatitis must be referred for alcohol rehabilitation, although the success rate for this rehabilitation is less than 25%. Mortality rates for severe alcoholic hepatitis range from 10% to 40% and are due to the complications of progressive hepatic dysfunction: hepatorenal syndrome, ascites with spontaneous bacterial peritonitis, sepsis, or gastrointestinal hemorrhage.

Meta-analyses of existing trials indicate that glucocorticoid therapy is associated with significant improvement in survival in severe alcoholic hepatitis. Glucocorticoids are contraindicated in the subgroup of patients with spontaneous bacterial peritonitis or gastrointestinal bleeding. This patient has no evidence of infection or gastrointestinal bleeding; she is a candidate for glucocorticoid therapy.

Abdominal ultrasonography does not support the diagnosis of cholelithiasis. Spontaneous bacterial peritonitis is not supported by the paracentesis. Pyleonephritis or alcohol withdrawal cannot account for her ascites, jaundice, and mental confusion.

[ArchivalUser]

Why not D, this pt has wbc of 17,000 plus fever-difficult to explain on the basis of alcoholic cirrhosis alone. A pt with cirhosis can have any infection and pyelo is a common disease and that is what can be closer, I think.
Please somebody give us the answer