Sandbox: Fatima

Sputum Analysis

Sputum Analysis

Acid Fast Stain

Culture on Sabourad's medium

Direct Microscopic Examination

Gentain Voilet Stain

Aerobic Culture

Tuberculosis

Yeast and Fungi

Actinomyces and other mycelia of Fungi

Fusiform Bacteria and Spirochetes

Pyogenic organsims

DD

Rhinitis

Positive Skin Prick or RAST

Negative Skin Prick or RAST

Allergic Rhinitis

Non Allergic

Infectious

Vasomotor

Gustatory

Nonallergic eosinophilic rhinitis syndrome (NARES)

Acute Rhinosinisitis

Chronic Rhinosinusitis

Approach

Diagnostic Paracentesis ❑ Perform ascitic fluid cell count and differential ❑ Perform ascitic fluid culture (Inoculated at bedside)

PMN ≥ 250cells/mm³

If YES ❑ Presumptive SBP ❑ Begin empiric antibiotic therapy(eg:Cefotaxime 2g IV q8H and ❑ IV Albumin on day 1 & day 3 IF serum creatinine 1mg/dl, BUN > 30mg/dl or total albumin > 4mg/dl

IF NO ❑ Look for the signs/symptoms of Infection

Is Culture Positive ?

Absent Symptoms ❑ Is Culture Positive?

Symptoms Present ❑ Begin Empiric Antibiotic Therapy for SBP

Negative Culture ❑ Complete 5 day Antibiotic Course

Confirmed SBP ❑ Narrow the spectrum based on the susceptibility to complete the 5 day course

Culture Negative ❑ No Antibiotics indicated

Culture Positive ❑ Bacterascites: Repeat diagnostic paracentesis when the culture growth is discovered

Diagnostic Paracentesis

Classification of acute abdomen based on etiology		Presentation	Symptoms			Signs			Diagnosis
			Fever	Abdominal Pain	Jaundice	Rigidity	Rebound Tenderness	Bowel sounds	Lab Findings	Imaging Findings	Additional Findings
Common causes of Peritonitis	Primary Peritonitis	Spontateous Bacterial Peritonitis
	Secondary Peritonitis	Perforated gastric and duodenal ulcer
		Acute Cholangitis
		Acute Cholecystitis
		Acute Pancreatitis
		Acute Appendicitis
		Acute Diverticulitis
		Acute Salphingitis
Hollow Viscous Obstruction		Small Intestine obstruction
		Volvulus
		Biliary Colic
		Renal Colic
Vascular Disorders	Ischemic causes	Mesentric Ischemia
		Acute Ischemic Colitis
	Hemorrhagic causes	Ruptured Abdominal Aortic Aneurysm
		Intraabdominal or Retroperitoneal Hemorrhage
Gynaecological Causes	Ovarian Cyst Complications	Torsion of the Cyst
		Cyst Rupture
	Pregnancy	Ruptured Ectopic Pregnancy

Prostatitis

History and Physical Examination

❑ Urine culture : All patients ❑ Postresidual : If indicated

Mild to Moderately Ill ❑ TMP/SMX 160/800mg PO BID for 6 weeks OR ❑ Ciprofloxacin 500mg PO BID for 6 weeks

Seriously ill or Possible urosepsis ❑ Admit patient for inpatient care ❑ Ampicillin 2g IV q6h PLUS Gentamicin 5mg/kg q24h or 1.5mg/kg every eight hours till afebrile

Fever Persists or Not Improving ❑ Non contrast Pelvic CT with cuts through the prostate or ❑ Transrectal Ultrasonography

Negative ❑ Modify antibiotics based on culture results

Positive ❑ Confirms diagnosis of Prostatic Abcess ❑ Consult urology for drainage

Afebrile ❑ ❑ TMP/SMX 160/800mg PO BID for 6 weeks OR ❑ Ciprofloxacin 500mg PO BID for 6 weeks