Mehlman IM/UW SBP+Cdiff 03-04 (3)

Question 1

SBP. 3 important scenarios?

Answer 1

know 3 causes of ascites:
cirrhosis
nephrotic. syndrome
recent perineal dialysis

Question 2

SBP. case example: cirrhosis + abd. pain + fever

Answer 2

ascitis factor is present –> SBP

Question 3

SBP. case example other.
cirrhosis + ascitis + pain of abdomen or fever is not mentioned + WBC > 900

Answer 3

SBP –> Tx abs

Question 4

SBP. NEXT BEST STEP?

Answer 4

PARACENTESIS

Question 5

SBP. after paracentesis –> ?

Answer 5

WBC + differential

WBC > 250 is diagnostic

Question 6

SBP. paracentesis –> WBC –> ?

Answer 6

gram stain + culture

Question 7

SBP Tx?

Answer 7

empiric - third gen. cephalosporins aka ceftriaxone

Question 8

SBP prophylaxis?

Answer 8

fluoroquinolones

Question 9

SBP. UW table. CP?3

Answer 9

temp > 37,8
abdominal pain/tenderness
Altered mental state (abnormal connect-the-numbers test)
Hypotension, hypothermia, paralytic ileus with severe infection

Question 10

SBP. UW table. diagnostic ascitis fluid?

Answer 10

PMN > 250
positive culture, often gram negative (E coli, klebsiela)
Protein <1
SAAG >= 1,1

SAAG - serum-ascites albumin gradient

Question 11

C. diff. mechanism
Abs –> decr. bowel flow –> c. diff overgroth

Answer 11

.

Question 12

C. diff.
Case: abs + diarrhea –> c.diff

Answer 12

.

Question 13

C. diff.
Starts 7-10 days from the onset of abs

Answer 13

.

Question 14

C. diff.
in what abdomen part cramping?

Answer 14

LLQ

vs Yearsinia RLQ

Question 15

C. diff.
diarrhea can be mentioned as bloody/watery

Answer 15

.

Question 16

C. diff. how acquired?

Answer 16

consumption of spores, not normal flora

Question 17

C. diff. its gram positive

Answer 17

.

Question 18

C. diff. Diagnosis?

Answer 18

stool toxins AB

culture is wrong answer

Question 19

C. diff. Tx?

Answer 19

VANCO oral

Question 20

C. diff. why vanko?

Answer 20

poorly absorbed p/os –> stays in GI

Question 21

C. diff.
fever + abdominal distension when diagnosed c diff –>? –>?

Answer 21

toxic megacolon –> do laparotomy

Question 22

UW table. c .diff. CP? 2

Answer 22

watery diarrhea (most common)

Fulminat colitis/toxic megacolon

Question 23

Tx UW table. c .diff.

Initial episode?

Answer 23

p/os vanco
OR
Fidaxomicin

Question 24

Tx UW table. c .diff.

first recurrence?

Answer 24

First recurrence:
Vanco p/os in prolonged course
OR
Fidaxomicin - if vanco was used in firstepisode

Question 25

Tx UW table. c .diff.

multiple recurrences?

Answer 25

Vanco followed by rifaximin
Fecal microbiota transplant

Question 26

Tx UW table. c .diff.

fulminant (hypotension/shock, ileus/magcolon)?

Answer 26

high-dose vanco p/o
+ metronidazole i/v

also surgery

Question 27

c .diff. case
28 y/o + LLQ pain + 7 days use abs + bloddy diarrhea = c.difd.

Answer 27

.

Question 28

SBP. On one of the newer peds forms, a vignette gives an 8-year-old with nephrotic syndrome who has a diffusely tender abdomen + fluid wave + fever; answer = paracentesis. Tx SBP with ceftriaxone.

Answer 28

Fluid wave is buzz word for ascitis

disease was mentioned minimal change disease (its nephrotic syndrome)