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6,453 edits
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==Diagnostic Paracentesis==
==Diagnostic Paracentesis==
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center class="wikitable" style="border: 2; background: none;"
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! colspan="1" rowspan="2" style="border: 1; background: 1;"| Classification of acute abdomen based on etiology
! colspan="2" rowspan="2" style="border: 1; background: 1;" | Classification of acute abdomen based on etiology
! colspan="1" rowspan="2"|Disease
! colspan="1" rowspan="2" |Presentation
! colspan="1" rowspan="2"|
! colspan="3" rowspan="1" | Symptoms
! colspan="2" rowspan="1"| Diagnosis
! colspan="1" rowspan="2" | Signs
! colspan="2" rowspan="1"| Mother to Child Transmission
! colspan="1" rowspan="2"| Most Serious Complications
|-
|-
! colspan="1" rowspan="1"| Laboratory studies || Clinical Diagnosis || Vertical Transmission || Trans-vaginal transmission
! colspan="1" rowspan="1"| Fever || Constipation || Jaundice
|-
|-
! colspan="1" rowspan="13"| Primarily sexually transmitted
! colspan="1" rowspan="8" | Common causes of Peritonitis
! colspan="1" rowspan="6"| '''Genital Dermatological Manifestation <br>(e.g., [[Genital ulcer|ulcers]], [[chancre]], vesicles, [[Genital warts|warts]], [[balanitis]] etc.)'''
! colspan="1" | Primary Peritonitis
| colspan="1" rowspan="1"| [[HPV]] || ✔ || ✔ ||  ||  || [[Cervical Cancer]]
| colspan="1" rowspan="1" | Spontateous Bacterial Peritonitis
|
|
|
|
|-
|-
| colspan="1" rowspan="1"| [[Herpes simplex]]-2 || ✔ || ✔ || ✔ || ✔ || Severe [[pruritis]]/discomfort
! colspan="1" rowspan="7" | Secondary Peritonitis
| colspan="1" rowspan="1" | Perforated gastric and duodenal ulcer || ✔ || || ✔ ||
*
|-
|-
| colspan="1" rowspan="1"| [[Syphilis]] || ✔ || ✔ || ✔ || ||
| colspan="1" rowspan="1" | Acute cholangitis || ✔ || ✔ || ✔ ||  
*Neurosyphilis<br>
*
*Cardiosyphilis
|-
|-
| colspan="1" rowspan="1"| [[Scabies]] || ✔ || ✔ ||  || || Moderate to Severe [[pruritis]]/discomfort
| colspan="1" rowspan="1" | Acute cholecystitis || ✔ || ✔ ||  ||  
|-
|-
| colspan="1" rowspan="1"| [[Pubic lice]] || ✔ || ✔ || ||  || Moderate to Severe [[pruritis]]/discomfort
| colspan="1" rowspan="1" | Acute pancreatitis || ✔ || ✔ ||  ||  
|-
|-
| colspan="1" rowspan="1"| [[Candidiasis]]<br>(in males) || || ✔ || || || Mild to moderate [[pruritis]]/discomfort
| colspan="1" rowspan="1" | Acute appendicitis || ✔ || ✔ || ✔ ||  
*
|-
|-
! colspan="1" rowspan="2"| '''Generalized Symptoms<br>(e.g. constitutional symptoms'''
| colspan="1" rowspan="1" | Acute diverticulitis || ✔ || ✔ || unknown ||  
| colspan="1" rowspan="1"| [[HIV]] || ✔ ||  || ✔ || ||
*[[Primary CNS Lymphoma]]<br>
*[[Immunosuppression]] (AIDS)
|-
|-
| colspan="1" rowspan="1"| [[Syphilis]] || ✔ || ✔ || ✔ ||  ||  
| colspan="1" rowspan="1" | Acute salphingitis || ✔ || ✔ || ||  
*Neurosyphilis<br>
*Cardiosyphilis
|-
|-
! colspan="1" rowspan="5"| '''Urogenital infections<br> (e.g.,[[Vaginitis]], [[Urethritis]], [[Cervicitis]], and [[PID]])'''
! colspan="2" | Hollow Viscous Obstruction
| colspan="1" rowspan="1"| [[Gonorrhea]] || ✔ || ✔ ||  || ✔ || [[PID]]
| colspan="1" rowspan="1" |Small Intestine obstruction
|-
|
| colspan="1" rowspan="1"|  [[Chlamydia]] || ✔ || ✔ ||  || ✔ || [[PID]]
|
|-
|
| colspan="1" rowspan="1"| [[Syphilis]] || ✔ || ✔ || ✔ ||  ||
|
*Neurosyphilis
*Cardiosyphilis
|-
| colspan="1" rowspan="1"| [[Mycoplasma genitalium infection|Mycoplasma genitalium]] || ✔ || ✔ || unknown || unknown || [[PID]]
|-
| colspan="1" rowspan="1"| [[Trichomonas vaginalis]] || ✔ || ✔ || ||  || [[PID]]
|-
! colspan="1" rowspan="6"| Less frequently sexually transmitted
! colspan="1" rowspan="3"| '''Generalized Symptoms<br>(e.g. constitutional symptoms)'''
| colspan="1" rowspan="1"| [[Zika virus infection|Zika Virus]] || ✔ ||  || ✔ ||  || [[Vertical transmission]] and congenital abnormalities
|-
| colspan="1" rowspan="1"|  [[Hepatitis B]] || ✔ || ✔ || ✔ ||  || [[Hepatocellular Carcinoma]]
|-
| colspan="1" rowspan="1"| [[Hepatitis C]] || ✔ || ✔ || ✔ ||  || [[Liver cirrhosis]]
|-
! colspan="1" rowspan="3"| '''Urogenital Infections <br> (e.g.,[[Vaginitis]], [[Urethritis]], [[Cervicitis]], and [[PID]])'''
| colspan="1" rowspan="1"| [[Gardnerella vaginalis]] || ✔ || ✔ ||  || || Moderate to severe discomfort
|-
| colspan="1" rowspan="1"|  [[Candidiasis]]<br>(in females) ||  || ✔ ||  ||  || Moderate to severe [[pruritis]]/discomfort
|-
| colspan="1" rowspan="1"| [[Ureaplasma urealyticum |Ureaplasma urealyticum]] || ✔ || ✔ ||  ||  || Moderate to severe [[pruritis]]/discomfort
|-
|-
|}
|}

Revision as of 20:19, 15 February 2017

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
Fever Constipation Jaundice
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 ✔ ✔ unknown
Acute salphingitis ✔ ✔
Hollow Viscous Obstruction Small Intestine obstruction
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