pls explain - nk26

[ArchivalUser]

1. A 70-year-old woman has had increasing abdominal pain 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]

CC

[ArchivalUser]

Actually i think it is A, acute abdomen with rebound tenderness , diverticulitis?

[ArchivalUser]

sorry i meant E

[ArchivalUser]

I think that even you might suspect diverticulitis, the first step would be paracentesis to check for high WBC with neutrophilia since she is treated with PD and is at high risk for SBP.

[ArchivalUser]

Someone said it is E, so I have my doubts even though my first impression was C.

[ArchivalUser]

this is a really good question.
people on dialysis usually have catheter related infection. this is usually by one organism, and is a skin dwelling bact like staph epi usually or a bact from the catheter.
It is not a an enteric bug as in SBP.
treatment should be intraperitoneal empiric eg. cefazolin+ceftriazone (gm +ve and gm-ve)
BUT NEVER VANCOMYCIN because we can very easily cause VRE
thus the asnwer to the question should be CCC according to me.

[ArchivalUser]

agree with you loooks like SBP....> so first gram stain.