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
			Fever	Abdominal Pain	Jaundice	Rigidity	Rebound Tenderness	Bowel sounds
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