Professional Documents
Culture Documents
1. Purulent profiles:
2. Lymphocytic - normal glucose
Pt: cloudy, pressure 220 mmH2O, cell 1100/mm3, PMN predominantly, protein 125 mg%, sugar 20 mg%
2. Lymphocytic - normal glucose CSF: normal ICP, normal or slightly increased protein
4. Eosinophilic CSF: high ICP, N/slightly high prot, sometime low sugar
Diagnosis of meningitis
1. Clinical syndrome of meningitis Clinical: fever + headache + neck stiffness Acute vs chronic 2. Source of infection Clinical: history, physical exam 3. Laboratory CSF exam, CT/MRI head, other fluid stain/culture, other lab chem: hemoculture, CBC, antibody titer, etc.
How to approach patient with CNS infection Does the patient have CNS infection? What is the location of infection? What is the nature (organism)? How to manage patient with CNS infection?
Treatment
1. Symptomatic : analgesic, anticonvulsant, etc. 2. In case of Herpes simplex encephalitis:
area of increased signal in the right temporal lobe confined predominantly to the gray matter.
3. Cerebral malaria: Artesunate/Quinine IV plasma exchange in case of hyerparasitemia + impaired consciousness (parasitemia > 10%)
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History in Ascites
Onset,progression,severity (breathing),precipitating and relieving factors Associated :fever, abdominal pain ,nausea,vomiting,jaundice Liver disease history:viral,alcoholic,etc,or established cirrhosis Previous Investigations or treatment Sacral, Scrotal and lower limbs edema Rule out other abdominal distension causes: Intestinal obstruction-Dilated bowel-Internal bleeding. Identify PPT factors of Ascites: compliance,diet,other
Khayyat ,Approach to peritoneal fluid analysis 23
Paracentesis Procedure
Indication: new onset Ascites in inpatient or outpatient . Ascitic Tapping ( movie demonstration) Prophylactic use of IV FFP or platelets is not needed before paracentesis. 15 gauge needle 3.25 inch is better than 14 gauge is more successful in obtaining paracentesis.
Khayyat ,Approach to peritoneal fluid analysis 25
SBP Culture negative neutrocytic Ascites Monomicrobial non neutrocytic Ascites Polymicrobial bacteriascites
Positive
No growth
Positive
Khayyat ,Approach to peritoneal fluid analysis
Positive
<250
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Remember at least 4 28
5 days of IV antibiotics
SBP
5 days of IV antibiotics
Polymicrobial bacteriascites
Hospitalization
Precipitati ng causes
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