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Tuberculous Peritonitis

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101. MKSAP: 68-year-old man with new-onset ascites

? A. Alcoholic cirrhosis B. Constrictive pericarditis C. Nonalcoholic cirrhosis D. Tuberculous peritonitis MKSAP Answer and Critique The correct answer is B. Constrictive pericarditis. The most likely diagnosis is constrictive pericarditis. This patient has undergone previous cardiac surgery, which is a risk factor for constrictive pericarditis. Ascitic fluid analysis should include measurement of albumin and total protein; cell count and bacterial cultures should be checked when infection is suspected (...) of this patient’s ascites. Tuberculous peritonitis is very uncommon and is associated with a SAAG less than 1.1 g/dL (11 g/L), an ascitic fluid total protein level greater than 3 g/dL (30 g/L), and a lymphocytic predominance in the cell count with differential. Although this patient has a high ascitic fluid total protein level, the SAAG is greater than 1.1 g/dL (11 g/L) and he does not have a predominance of lymphocytes on the ascitic fluid cell count. Key Point A serum-ascites albumin gradient (SAAG) of 1.1 g

2017 KevinMD blog

102. Ventriculo-ureteral shunt insertion using percutaneous nephrostomy: a novel minimally invasive option in a patient with chronic hydrocephalus complicated by multiple distal ventriculoperitoneal shunt failures. Full Text available with Trip Pro

Ventriculo-ureteral shunt insertion using percutaneous nephrostomy: a novel minimally invasive option in a patient with chronic hydrocephalus complicated by multiple distal ventriculoperitoneal shunt failures. The management of ventriculoperitoneal (VP) shunt failure is a common problem in neurosurgical practice. On occasion, extraperitoneal sites for CSF diversion are required when shunting to the peritoneal cavity has failed after multiple attempts. The authors report a novel minimally (...) invasive procedure allowing cannulation of the ureter for the purpose of ventriculo-ureteral (VU) shunting. Sixteen years prior to presentation, this 46-year-old woman had contracted tuberculous meningitis and had chronic hydrocephalus, with multiple distal shunt failures in recent months. A percutaneous nephrostomy was used to pass the distal catheter based on intraoperative retrograde pyelography. Following successful placement of the VU shunt, the patient's hydrocephalus stabilized and she returned

2016 Journal of Neurosurgery

103. Tuberculose péritonéale: aspect laparoscopique de pelvis gelé Full Text available with Trip Pro

, Tunisie. fre Case Reports Journal Article Tuberculose péritonéale: aspect laparoscopique de pelvis gelé. 2016 10 17 Uganda Pan Afr Med J 101517926 0 Antibiotics, Antitubercular 0 Antitubercular Agents IM Abdomen diagnostic imaging Adult Antibiotics, Antitubercular therapeutic use Antitubercular Agents therapeutic use Ascites Diagnosis, Differential Female Humans Laparoscopy Mycobacterium tuberculosis isolation & purification Peritonitis, Tuberculous diagnosis drug therapy pathology Ultrasonography (...) Tuberculose péritonéale: aspect laparoscopique de pelvis gelé 28292044 2018 02 15 2018 02 15 1937-8688 25 2016 The Pan African medical journal Pan Afr Med J [Peritoneal tuberculosis]. 81 10.11604/pamj.2016.25.81.10037 Kehila Mehdi M Service C de Gynécologie Obstétrique, Centre de Maternité et de Néonatologie de Tunis, Université Tunis El Manar, Tunisie. Chanoufi Mohamed Badis MB Service C de Gynécologie Obstétrique, Centre de Maternité et de Néonatologie de Tunis, Université Tunis El Manar

2016 The Pan African medical journal

104. Abdominal tuberculosis: an old disease surprising young doctors Full Text available with Trip Pro

Abdominal tuberculosis: an old disease surprising young doctors Tuberculosis remains a worldwide public health concern. Atypical extrapulmonary presentations may delay the diagnosis and treatment. We present the case of an adult woman admitted to the emergency department with bowel obstruction. The putative intraoperative diagnostic hypothesis was ovarian cancer with peritoneal dissemination. Histopathological analysis showed a chronic granulomatous inflammatory disease with acid-fast bacilli (...) . The patient was started on an alternative parenteral antituberculosis drug combination until oral feeding was available. Currently, 5 months after surgery, she is asymptomatic. Abdominal tuberculosis is the most frequent extrapulmonary site with a wide range of clinical presentations. Emergency laparotomy may be necessary in patients who present with acute abdomen. Bowel obstruction due to adhesions and strictures is not infrequent. However, tuberculous abdominal cocoon presentation as in our patient

2016 BMJ case reports

105. A case report of racemose pattern of intracranial tuberculoma with brain stem and hypophyseal involvement developing paradoxically during treatment. Full Text available with Trip Pro

transplantation, the incidence of tubercular infections has been rising in developed countries. The authors report a case of intracranial tuberculosis in a human immunodeficiency virus-negative patient, who underwent incomplete treatment for tubercular peritonitis and presented with unilateral ptosis. Tuberculous involvement was noted in a racemose pattern in the subarachnoid space, cavernous sinuses, suprasellar cistern and parasellar region. To the best of our knowledge, the term racemose pattern

2016 BJR | case reports

106. Ascites and adnexal masses: not always ovarian or tubal carcinoma Full Text available with Trip Pro

, Hospital de Braga, Braga, Portugal. Serrano Paula P Gynecology and Obstetrics Department, Hospital de Braga, Braga, Portugal. eng Case Reports Journal Article 2016 11 22 England BMJ Case Rep 101526291 1757-790X 0 CA-125 Antigen IM Adenocarcinoma diagnosis Adnexal Diseases diagnosis microbiology Adult Ascites microbiology CA-125 Antigen blood Diagnosis, Differential Fallopian Tube Neoplasms diagnosis Female Humans Ovarian Neoplasms diagnosis Peritonitis, Tuberculous diagnosis microbiology Conflicts

2016 BMJ case reports

107. Primary gastric tuberculosis presenting as gastric outlet obstruction: a case report and review of the literature Full Text available with Trip Pro

, cryptitis and multiple lymphoid follicles, no malignancy seen. Sonographic test showed hypodense pyloric mass, enlarged para-aortic and mesenteric lymph nodes and mild pelvic ascites. A computed tomography scan of the abdomen and pelvis showed antral hypodense lesions multiple mesenteric lymphadenopathies peritoneal thickening and ascites. Chest X-ray was normal. Intra-operative findings were dilated stomach and pylorus mass with multiple mesenteric lymph nodes, peritoneal and omental seedlings all over (...) with small nodules on the surface of the liver, gastro-jejunostomy was done. Histopathology confirmed the diagnosis of abdominal tuberculosis. Postoperative event was uneventful. Patient received anti-tuberculous.Here we presented an unusual case of gastric outlet obstruction due to primary gastric tuberculosis, patient underwent surgery to relief his symptoms and received anti-tuberculous.

2015 Journal of medical case reports

108. Clinical Trials of N-acetyl Glucosamine Capsule for IBS-D Treatment

-intestinal disease of digestive system such as Peptic ulcer, tuberculous peritonitis, cirrhosis etc. Heart, lung, kidney and other important organs have severe lesions, immune regulatory disease, metabolic disease (diabetes, thyroid disease) or malignant tumor, reproductive system diseases such as ovarian cysts, endometriosis, etc. Laboratory tests or Electrocardiogram were significantly abnormal, and judging by the researchers may damage the patient safety or successful completion of the clinical

2015 Clinical Trials

109. Multiple, Pan-Enteric Perforation Secondary to Intestinal Tuberculosis Full Text available with Trip Pro

Multiple, Pan-Enteric Perforation Secondary to Intestinal Tuberculosis Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. Herein, we describe a case of a 25-year-old male who presented with generalized peritonitis requiring an emergency exploratory laparotomy, which revealed pan-enteric perforation characterized by multiple perforations (...) of the small bowel extending 10-15 cm from the DJ flexure up to the terminal ileum. The perforations were primarily closed, while 6-8 cm of the diseased terminal ileum was resected and the two ends were brought out as double-barreled ostomy. To the best of our knowledge, such an extensive tuberculous perforation of the small bowel has not been previously reported in the literature before.

2015 Case reports in surgery

110. Surgical treatment of lumbosacral tuberculosis by one-stage debridement and anterior instrumentation with allograft through an extraperitoneal anterior approach Full Text available with Trip Pro

was exposed via an anterior midline retroperitoneal approach. After radical debridement, two parallel tricortical iliac crest bone allografts were placed to reconstruct the anterior column, and then anterior fixation was performed.The mean follow-up period was 34 months (range, 24-91 months), during which no obvious loss of correction was observed. No case experienced recurrence, tuberculous peritonitis, erectile dysfunction, or retrograde ejaculation.The midline retroperitoneal approach provides direct

2015 Journal of orthopaedic surgery and research

111. CPG on the Diagnosis, Treatment and Prevention of Tuberculosis

tuberculosis depends on the organ or system affected. A chest X ray should always be performed in order to rule out pulmonary tuberculosis. STRONG In additional to microbiological and histological analysis of the sample, a rapid diagnostic method should also be used if treatment needs to be started early, such as in tuberculous meningitis or severe disseminated tuberculosis. Diagnosing resistance to tuberculosis drugs v Sensitivity tests for first-line drugs should be performed on initial isola- tion (...) for patients with osteoarticular tuberculosis, depending on their clinical and radiological development. STRONG Patients with tuberculous meningitis must follow a longer treatment regi- men, lasting up to 12 months. STRONG In patients with stage II or III tuberculous meningitis, adjuvant corticos- teroid treatment is recommended during the initial phase (prednisolone 60 mg/day for 4 weeks). WEAK In children with tuberculous meningitis, adjuvant corticosteroid treat- ment is recommended during the initial

2010 GuiaSalud

112. Role of transgastric natural orifice transluminal endoscopic surgery in the diagnosis of ascites of unknown origin (with videos). (Abstract)

transgastric NOTES.Characteristic of ascites cases, conditions of the abdominal cavity, diagnostic accuracy, adverse events, and follow-up time.Transgastric NOTES was performed successfully in 78 patients with ascites of unknown origin, and 72 cases (92.3%) were clearly diagnosed. They included malignant tumors (39 cases), tuberculous peritonitis (28 cases), chronic hepatic inflammation (3 cases), necrotizing lymphadenitis (1 case), and eosinophilic serositis of the small intestine (1 case). In addition (...) , there were 6 nondiagnostic cases, and no severe adverse events were found.Nonrandomized control analysis.Transgastric NOTES in combination with biopsy can elucidate the causes of ascites of unknown origin in the majority of cases. Therefore, it is a feasible and effective approach to access the peritoneal cavity and also a valuable modality to detect the cause of diseases with ascites of unknown origin.Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights

2014 Gastrointestinal endoscopy

113. MAIT Cell Function is Modulated by PD-1 Signaling in Patients with Active Tuberculosis. (Abstract)

with pulmonary TB, tuberculous pleurisy, and tuberculous peritonitis by flow cytometry. The functions of MAIT cells were compared between patients with active TB and healthy control subjects.The frequency of MAIT cells was significantly reduced both in peripheral blood from patients with active pulmonary TB (P < 0.0001) and in tuberculous pleural effusions compared with healthy control subjects but not in ascitic fluids from patients with tuberculous peritonitis. A comparison of bacillus Calmette-Guérin (BCG

2014 American Journal of Respiratory and Critical Care Medicine

114. Tuberculosis of the Genitourinary System (Overview)

of hematologic spread of infection , whereas adults seem to develop tuberculous epididymoorchitis caused by direct spread from the urinary tract. [ ] The formation of a draining sinus is uncommon in developed countries, but epididymal induration and beading of the vas are common. Involvement of the testis is usually due to direct extension. Infertility may result from bilateral vasal obstruction. Nodular beading of the vas is a characteristic physical finding, and orchitis and the resulting testicular (...) is secondary to genital TB. Patients with genital and urethral TB present with a superficial tuberculous ulcer on the penis or in the female genital tract secondary to mycobacteria exposure during intercourse. The penile ulcer may cause cavernositis that extends to the urethra. This form of TB may involve the uterus and fallopian tubes, causing strictures. Consider malignancy if genital ulcers are present. Acute urethritis manifests as mycobacterial discharge and often results in chronic stricture

2014 eMedicine.com

115. Cirrhosis (Overview)

America and Europe are cirrhosis, neoplasm, congestive heart failure, and tuberculous peritonitis. In the past, ascites was classified as being a transudate or an exudate. In transudative ascites, fluid was said to cross the liver capsule because of an imbalance in Starling forces. In general, ascites protein would be less than 2.5 g/dL in this form of ascites. A classic cause of transudative ascites would be portal hypertension secondary to cirrhosis and congestive heart failure. In exudative ascites (...) , fluid was said to weep from an inflamed or tumor-laden peritoneum. In general, ascites protein in exudative ascites would be greater than 2.5 g/dL. Causes of the condition would include peritoneal carcinomatosis and tuberculous peritonitis. Nonperitoneal causes Attributing ascites to diseases of nonperitoneal or peritoneal origin is more useful. Thanks to the work of Bruce Runyon, the serum-ascites albumin gradient (SAAG) has come into common clinical use for differentiating these conditions

2014 eMedicine.com

116. Chronic Pain Syndrome (Overview)

Ovarian dystrophy or ovulatory pain Pelvic congestion syndrome Postoperative peritoneal cysts Residual accessory ovary Subacute salpingo-oophoritis Tuberculous salpingitis Reproductive disorders (uterine) Uterine reproductive disorders associated with chronic pain include the following: Adenomyosis Chronic endometritis Atypical dysmenorrhea or ovulatory pain Cervical stenosis Endometrial or cervical polyps Leiomyomata Symptomatic pelvic relaxation (genital prolapse) An intrauterine contraceptive

2014 eMedicine.com

117. Atypical Mycobacterial Diseases (Overview)

, Rengasamy G, Madasamy B, Kulanthaivelu A, Subramanian G. Subcutaneous aspergillosis with coexisting atypical mycobacterial infection. Indian J Pathol Microbiol . 2010 Apr-Jun. 53(2):359-60. . Seidl A, Lindeque B. Large joint osteoarticular infection caused by Mycobacterium arupense. Orthopedics . 2014 Sep. 37(9):e848-50. . Hauch A, Ory B, Paramesh A. Atypical mycobacterial infections of peritoneal dialysis catheter exit sites - a louisiana issue. J La State Med Soc . 2014 Sep-Oct. 166(5):213-6 (...) . Sporotrichoid dermatosis caused by Mycobacterium abscessus from a public bath. J Dermatol . 2000 Apr. 27(4):264-8. . Edeer Karaca N, Boisson-Dupuis S, et al. Granulomatous skin lesions, severe scrotal and lower limb edema due to mycobacterial infections in a child with complete IFN-? receptor-1 deficiency. Immunotherapy . 2012 Nov. 4(11):1121-7. . Pai HH, Chen WC, Peng CF. Isolation of non-tuberculous mycobacteria from hospital cockroaches (Periplaneta americana). J Hosp Infect . 2003 Mar. 53(3):224-8

2014 eMedicine.com

118. Virtual Reality Biofeedback in Chronic Pain and Psychiatry (Overview)

remnant syndrome Ovarian dystrophy or ovulatory pain Pelvic congestion syndrome Postoperative peritoneal cysts Residual accessory ovary Subacute salpingo-oophoritis Tuberculous salpingitis Reproductive disorders (uterine) Uterine reproductive disorders associated with chronic pain include the following: Adenomyosis Chronic endometritis Atypical dysmenorrhea or ovulatory pain Cervical stenosis Endometrial or cervical polyps Leiomyomata Symptomatic pelvic relaxation (genital prolapse) An intrauterine

2014 eMedicine.com

119. Trematode Infection (Overview)

metacercariae. This is the infective stage for the mammalian host (5). Human infection with Paragonimus westermani occurs by eating inadequately cooked or pickled crab or crayfish that harbor metacercariae of the parasite (6). The metacercariae excyst in the duodenum (7), penetrate through the intestinal wall into the peritoneal cavity, and then through the abdominal wall and diaphragm into the lungs, where they become encapsulated and develop into adults (8) (7.5-12 mm X 4-6 mm). The worms can also reach (...) cercariae. Table 3. Comparative Features of Major Human Schistosoma Species S haematobium S mansoni S japonicum Adult Body surface of male Finely tuberculate Grossly tuberculate Nontuberculate (smooth) Testes 4-6, in a cluster 6-9, in a cluster 7, in a linear series Position of ovary Posterior to middle of body Anterior to middle of body Posterior to middle of body Number of eggs in uterus 20-30 1-4 50-300 Egg Size and shape 110-170 μm long 40-70 μm wide Terminal spine 114-175 μm long 45-68 μm wide

2014 eMedicine.com

120. Epididymal Tuberculosis (Overview)

of infection , whereas adults seem to develop tuberculous epididymoorchitis caused by direct spread from the urinary tract. [ ] The formation of a draining sinus is uncommon in developed countries, but epididymal induration and beading of the vas are common. Involvement of the testis is usually due to direct extension. Infertility may result from bilateral vasal obstruction. Nodular beading of the vas is a characteristic physical finding, and orchitis and the resulting testicular swelling can be difficult (...) . Patients with genital and urethral TB present with a superficial tuberculous ulcer on the penis or in the female genital tract secondary to mycobacteria exposure during intercourse. The penile ulcer may cause cavernositis that extends to the urethra. This form of TB may involve the uterus and fallopian tubes, causing strictures. Consider malignancy if genital ulcers are present. Acute urethritis manifests as mycobacterial discharge and often results in chronic stricture formation. Next: Causative

2014 eMedicine.com

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