Abdomen

Question 1

Most likely diagnosis?

Older female, worked at shipyard, ex-smoker, hx of breast CA (s/p mastectomy & chemo).

Weight gain, abd distention

Answer 1

Primary peritoneal mesothelioma

MC primary peritoneal malignancy

Asbestos (shipyard) is RF

Question 2

Mesenteric cyst

Answer 2

Unilocular cyst within small bowel mesentery. No solid components. Unattached to small bowel.

Question 3

Intestinal duplication cyst

Answer 3

cystic structure that communicates with/attached to adjacent bowel.

Question 4

Absolute contra-indication for peritoneal dialysis

Answer 4

Lack of functional peritoneal membrane

Question 5

Relative contra-indication for peritoneal dialysis

Answer 5

peritoneal scarring
physical/psych impairment
lack of appropriate environment
anuria
large patient size
active inflammatory process
surgical ostomies
large abdominal wall hernia
ventriculoperitoneal shunts

Question 6

Cause of Peritoneal dialysis-related peritonitis

Answer 6

contamination with skin flora during exchanges or due to tunnel infection

Question 7

Gastrinoma

Answer 7

MC sporadic (80%)
Familial (20%) - assoc w/ MEN-1

> 60% are malignant

Male predominant - 2:1

secretory diarrhea (2/2 gastric acid hypersecretion)

prox duodenum is MC site of ulcer

Question 8

Chylous ascites

Answer 8

Peritoneal fluid, milky/cloudy fluid
Occurs 2/2 disruption of lymphatic system
Causes: malignant obstruction, congenital abnormalities, thoracic duct obstruction from trauma or surgery.

In US: abd malignancy (MCC in adults - lymphoma is MCC), lymphatic abnormalities, and cirrhosis

Developing countries: infectious (TB, filariasis, mycobacterium aviarum)

In kids: congenital abnormalities

Fluid analysis: TG >200, Cell count > 500, total protein 2.5 - 7.0, serum ascites albumin gradient <1.1, low cholesterol, LDH 110-200, glucose <100

Question 9

Spontaneous bacterial peritonitis

Answer 9

High ascitic fluid w/ absolute PMN count >=250 cells/mm3, positive ascitic fluid bacterial culture, absence of secondary causes of peritonitis

Question 10

Secondary bacterial peritonitis

Answer 10

High ascitic fluid w/ absolute PMN count >=250 cells/mm3, positive ascitic fluid bacterial culture, in setting of surgically treatable intra-abs source of infection
Total protein >1
Glucose <50
LDH > upper limit of normal for serum