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Tuberculous Peritonitis

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161. Pleural Effusion (Overview)

of conditions, including empyema; rheumatoid, tuberculous, or lupus pleuritis; malignancy; urinothorax; or esophageal rupture. [ ] Cytologic analysis ­- Especially if malignancy is suspected. In the appropriate clinical setting, Gram staining, acid­-fast bacilli staining, and culture and sensitivity for aerobic and anaerobic organisms and fungi. Additional studies should be requested on the basis of the gross appearance of the pleural fluid or when a specific condition is suspected. Procalcitonin and C (...) , and an absence of air bronchograms. A massive effusion is often attributable to an underlying malignancy. Other conditions that must be considered include the following: Congestive heart failure Tuberculosis (TB) Cirrhosis with ascites Transdiaphragmatic rupture of a liver abscess into the pleural space (>90% right-sided) Paragonimiasis (usually unilateral) Peritoneal dialysis (90% right sided) Cryptococcosis Pancreatic pseudocyst Chronic pancreatitis Meigs syndrome Uremic pleuritis Yellow nail syndrome

2014 eMedicine Emergency Medicine

162. Colon, Adenocarcinoma

cancers show calcification in the primary tumor and in hepatic and peritoneal secondary deposits visible on radiographs. Double-contrast barium enema is one of the modalities approved for colon cancer screening, but the frequency of its use has markedly decreased over the past decade. As Ferrucci et al note, [ ] “DCBE [double-contrast barium enema] is a low-yield procedure for detecting polyps, with a high false-positive rate, and is not likely to be performed by experienced practitioners (...) An example of a postoperative complication is shown below. Postoperative complication: Anastomotic breakdown after right hemicolectomy in patient with Serratia sepsis. CT showing extravasation into peritoneal collection, superior mesenteric vein (SMV) thrombus. CT in surveillance after colon cancer therapy Surveillance guidelines recommend annual CT surveillance of the chest, abdomen, and pelvis, [ ] in addition to frequent clinical evaluation, CEA testing, and follow-up colonoscopy. The American Society

2014 eMedicine Radiology

163. Pleural Effusion (Diagnosis)

of conditions, including empyema; rheumatoid, tuberculous, or lupus pleuritis; malignancy; urinothorax; or esophageal rupture. [ ] Cytologic analysis ­- Especially if malignancy is suspected. In the appropriate clinical setting, Gram staining, acid­-fast bacilli staining, and culture and sensitivity for aerobic and anaerobic organisms and fungi. Additional studies should be requested on the basis of the gross appearance of the pleural fluid or when a specific condition is suspected. Procalcitonin and C (...) , and an absence of air bronchograms. A massive effusion is often attributable to an underlying malignancy. Other conditions that must be considered include the following: Congestive heart failure Tuberculosis (TB) Cirrhosis with ascites Transdiaphragmatic rupture of a liver abscess into the pleural space (>90% right-sided) Paragonimiasis (usually unilateral) Peritoneal dialysis (90% right sided) Cryptococcosis Pancreatic pseudocyst Chronic pancreatitis Meigs syndrome Uremic pleuritis Yellow nail syndrome

2014 eMedicine Emergency Medicine

164. Pericarditis, Constrictive-Effusive (Diagnosis)

that in patients with tuberculous pericardial effusion, right atrial pressure and interleukin-10 (IL-10) levels were higher in those with effusive-constrictive pericarditis. The study included 68 patients with tuberculous pericardial effusion, 36 of whom had effusive-constrictive pericarditis. The investigators determined that the latter group had a right atrial pressure of 17.0 mmHg, versus 10.0 mmHg in the other patients, prior to pericardiocentesis. In addition, the serum and pericardial concentrations (...) of IL-10 were 38.5 and 84.7 pg/mL, respectively, in the patients with effusive-constrictive pericarditis, compared with 0.2 and 20.4 pg/mL, respectively, for the patients with nonconstrictive tuberculous pericardial effusion. [ ] Effusive-constrictive pericarditis may be part of a clinical continuum. Stages of infective pericarditis have been observed that range from acute pericarditis and tamponade with effusion to constrictive pericarditis without effusion. Effusive-constrictive pericarditis

2014 eMedicine.com

165. Pericardial Effusion (Diagnosis)

). (See , , , and .) This image is from a patient with malignant pericardial effusion. Note the "water-bottle" appearance of the cardiac silhouette in the anteroposterior (AP) chest film. Embryology In the human embryo, the pericardial cavity develops from the intraembryonic celom during the fourth week. The pericardial cavity initially communicates with the pleural and peritoneal cavities, but during normal development these are separated by the eighth week. The visceral and parietal pericardium (...) , which is associated with effusions in other body cavities The most common cause of and myocarditis is viral. Common etiologic organisms include coxsackievirus A and B, and hepatitis viruses. Other forms of infectious pericarditis include the following: Pyogenic - Pneumococci, streptococci, staphylococci, Neisseria , Legionella species Tuberculous Fungal - Histoplasmosis, coccidioidomycosis, Candida Syphilitic Protozoal Parasitic Neoplastic Neoplastic disease can involve the pericardium through

2014 eMedicine.com

166. Pleural Effusion (Diagnosis)

); this is known as "trapped lung" (eg, extensive atelectasis due to an obstructed bronchus or contraction from fibrosis leading to restrictive pulmonary physiology) Decreased lymphatic drainage or complete lymphatic vessel blockage, including thoracic duct obstruction or rupture (eg, malignancy, trauma) Increased peritoneal fluid with microperforated extravasation across the diaphragm via lymphatics or microstructural diaphragmatic defects (eg, , cirrhosis, peritoneal dialysis) Movement of fluid from (...) squeezed out of the pleura as a result of an imbalance in hydrostatic and oncotic forces in the chest. However, other mechanisms of injury may include upward movement of fluid from the peritoneal cavity or, in iatrogenic cases, direct infusion into the pleural space from misplaced (or even migrated) central venous catheters or nasogastric feeding tubes. Transudates are caused by a small, defined group of etiologies, including the following: Congestive heart failure Cirrhosis (hepatic hydrothorax

2014 eMedicine.com

167. Tuberculosis, Gastrointestinal

from Crohn disease and other inflammatory disorders, laparoscopy with a targeted biopsy is currently considered the most rapid and specific method for diagnosing GI TB. TB is a well-recognized cause of rectal stricture in the Asian population. Isolated rectal involvement is rare and may be mistaken for rectal malignancy. Other diagnostic studies The measurement of ascitic fluid adenosine deaminase levels is a major advance in the diagnosis of tuberculous peritonitis, which should be considered when (...) . Radiologic features and pathologic correlation to the pattern of tuberculous infection in the GI tract is discussed in this article (see the images below). Overall, one third of the world's population is infected with the TB bacillus, but not all infected individuals have clinical disease. [ ] The bacteria cause the disease when the immune system is weakened, as in older patients and in patients who are HIV positive. The control of TB has been challenging because of the natural history of the disease

2014 eMedicine Radiology

168. Tuberculosis, Genitourinary Tract

testicular disease. In patients with female genital tract tuberculosis, awareness of ultrasonographic changes associated with tuberculous infection may improve diagnostic accuracy and help the clinician to avoid clinical mismanagement and surgical explorations in patients with genital infections associated with wet-type tuberculosis (peritonitis). [ , , , , , , , , , , , ] Limitations of techniques All imaging findings may be normal in patients with early genitourinary tuberculosis. Genitourinary (...) causes. Previous Next: Magnetic Resonance Imaging MRI is good at depicting tuberculous cavities, sinuses tracts, fistulous communications, and extrarenal and extraprostatic spread. Multiplanar MRI allows evaluation of the disease extent in the prostatic bed and the presence of sinuses and fistulae. MRI contrast agents facilitate evaluation. MRI is also useful in the evaluation of peritonitis and adnexal masses. [ ] Renal parenchymal changes not dissimilar to acute pyelonephritis occur in renal

2014 eMedicine Radiology

169. Pelvic Inflammatory Disease/Tubo-ovarian Abscess

such as or may occur. Hematogenous infection is a rare cause of PID except in cases of tuberculous PID. [ , ] Douching is a potential risk factor for PID as it can result in a change of the vaginal flora and introduce bacteria from the vagina into the upper reproductive organs. Usage of intrauterine contraceptive device or gynecologic interventions may also predispose a patient to PID. Direct extension of infection from adjacent viscera and uterine instrumentation are more important risk factors (...) . Contrast-enhanced CT demonstrates large bilateral tubular and cystic fluid collections with wall enhancement, suggestive of tubo-ovarian abscesses. There is also pelvic free fluid and extensive fat stranding. Bilateral tubo-ovarian abscesses seen as thick-walled, rim-enhancing tubular fluid collections with incomplete septae. The ovaries are not separately visualized. Pelvic peritonitis The inflammation can spread to involve the peritoneum, which shows enhancement on a postcontrast study. There can

2014 eMedicine Radiology

170. Portal Hypertension

. Often, the attenuation of a cirrhotic liver is homogeneous and within the reference range. CT scan through the spleen of a 43-year-old man with a known history of intravenous drug abuse and hepatitis C cirrhosis. The patient presented to the emergency department with a sudden onset of a hypotensive episode and clinical features of hepatic encephalopathy. The scan shows splenomegaly with a dilated tortuous splenic vein/varices at the splenic hilum and free peritoneal fluid. The final diagnosis (...) fibrosis is characteristically of low attenuation and tends to become isoattenuating or minimally hypoattenuating after the intravenous administration of contrast material. Thus, confluent fibrosis is frequently missed if only contrast-enhanced CT is used. Collateral veins are occasionally seen in the peritoneal cavity, the retroperitoneum, the abdominal wall, and the mediastinum. In the presence of hemochromatosis, liver attenuation is increased because of excessive iron load. As a result of poor

2014 eMedicine Radiology

171. Pleural Effusion (Treatment)

of conditions, including empyema; rheumatoid, tuberculous, or lupus pleuritis; malignancy; urinothorax; or esophageal rupture. [ ] Cytologic analysis ­- Especially if malignancy is suspected. In the appropriate clinical setting, Gram staining, acid­-fast bacilli staining, and culture and sensitivity for aerobic and anaerobic organisms and fungi. Additional studies should be requested on the basis of the gross appearance of the pleural fluid or when a specific condition is suspected. Procalcitonin and C (...) , and an absence of air bronchograms. A massive effusion is often attributable to an underlying malignancy. Other conditions that must be considered include the following: Congestive heart failure Tuberculosis (TB) Cirrhosis with ascites Transdiaphragmatic rupture of a liver abscess into the pleural space (>90% right-sided) Paragonimiasis (usually unilateral) Peritoneal dialysis (90% right sided) Cryptococcosis Pancreatic pseudocyst Chronic pancreatitis Meigs syndrome Uremic pleuritis Yellow nail syndrome

2014 eMedicine Emergency Medicine

172. Pericarditis and Cardiac Tamponade (Treatment)

(all level C evidence) [ ] Pericardiectomy is the treatment mainstay of chronic permanent constriction (class I). To prevent progression of constriction, administer medical therapy for specific pericarditis conditions (ie, tuberculous pericarditis) (class I). Consider empiric anti-inflammatory therapy in the setting of transient or new diagnosis of constriction with concomitant evidence of pericardial inflammation (ie, elevated CRP or pericardial enhancement on computed tomography scan/cardiac (...) pericardiectomy. Tubercular infection is managed with the usual antituberculous chemotherapy. The 2015 updated ESC guidelines recommend consideration of intrapericardial urokinase to reduce the risk of constriction in tuberculous effusive pericarditis (class IIb, level C evidence). [ ] Controversy exists regarding the use of steroids in the treatment of tuberculous pericarditis. The ESC 2004 guideline advises using corticosteroid therapy only in patients with secondary tuberculous pericarditis, and only

2014 eMedicine Emergency Medicine

173. Ascites (Diagnosis)

(>1.1 g/dL) (see the calculator). Spontaneous bacterial peritonitis may complicate the course of the disease. Cardiac abnormalities (eg, congestive failure, physiologic right-side heart obstruction, severe valvular regurgitation) may result in ascites. Infection may lead to excess peritoneal fluid. Appendicitis is common in patients in developed countries, whereas tuberculous fluid collections and Salmonella organisms are observed in patients in the developing world. Pancreatic ascites (either from (...) cholecystectomy. Urinary ascites in neonates is usually due to intraperitoneal bladder or ureteric or upper-tract perforation as a result of distal obstruction. Posterior urethral valves are the most common cause; [ ] for this reason, males are affected much more often than females are. Complex urinary anomalies (eg, persistent cloaca) may allow reflux of urine through the genital tract into the peritoneal cavity, without the presence of a perforation. [ ] Chylous ascites may occur in neonates

2014 eMedicine Pediatrics

174. Tuberculosis (Overview)

, or axillary lymph nodes. Typically, infected lymph nodes are firm and nontender with nonerythematous overlying skin. The nodes are initially nonfluctuant. Suppuration and spontaneous drainage of the lymph nodes may occur with caseation and the development of necrosis. A study reported on the accuracy and safety of endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) for the diagnosis of tuberculous mediastinal lymphadenitis. The study concluded that EBUS-TBNA is a safe and well (...) node tissue, bone marrow, blood, liver, cerebrospinal fluid (CSF), urine, and stool may be useful, depending on the location of the disease. Decontamination of other microorganisms in the specimens obtained may be performed by the addition of sodium hydroxide, usually in combination with N -acetyl- L -cysteine. Other body fluids (eg, CSF, pleural fluid, peritoneal fluid) can also be centrifuged; the sediment can be stained and evaluated for presence of acid-fast bacilli (AFB). CSF smear results

2014 eMedicine Pediatrics

175. Ascites (Follow-up)

(>1.1 g/dL) (see the calculator). Spontaneous bacterial peritonitis may complicate the course of the disease. Cardiac abnormalities (eg, congestive failure, physiologic right-side heart obstruction, severe valvular regurgitation) may result in ascites. Infection may lead to excess peritoneal fluid. Appendicitis is common in patients in developed countries, whereas tuberculous fluid collections and Salmonella organisms are observed in patients in the developing world. Pancreatic ascites (either from (...) cholecystectomy. Urinary ascites in neonates is usually due to intraperitoneal bladder or ureteric or upper-tract perforation as a result of distal obstruction. Posterior urethral valves are the most common cause; [ ] for this reason, males are affected much more often than females are. Complex urinary anomalies (eg, persistent cloaca) may allow reflux of urine through the genital tract into the peritoneal cavity, without the presence of a perforation. [ ] Chylous ascites may occur in neonates

2014 eMedicine Pediatrics

176. Tuberculosis (Diagnosis)

, or axillary lymph nodes. Typically, infected lymph nodes are firm and nontender with nonerythematous overlying skin. The nodes are initially nonfluctuant. Suppuration and spontaneous drainage of the lymph nodes may occur with caseation and the development of necrosis. A study reported on the accuracy and safety of endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) for the diagnosis of tuberculous mediastinal lymphadenitis. The study concluded that EBUS-TBNA is a safe and well (...) node tissue, bone marrow, blood, liver, cerebrospinal fluid (CSF), urine, and stool may be useful, depending on the location of the disease. Decontamination of other microorganisms in the specimens obtained may be performed by the addition of sodium hydroxide, usually in combination with N -acetyl- L -cysteine. Other body fluids (eg, CSF, pleural fluid, peritoneal fluid) can also be centrifuged; the sediment can be stained and evaluated for presence of acid-fast bacilli (AFB). CSF smear results

2014 eMedicine Pediatrics

177. Vascular Disorders of the Liver

ulcer Cholecystitis Tuberculous lymphadenitis Crohn’s disease, Ulcerative colitis Cytomegalovirus hepatitis Injury to the portal venous system Splenectomy Colectomy, Gastrectomy Cholecystectomy Liver transplantation Abdominal trauma Surgical portosystemic shunting, TIPS, Liver transplantation Cirrhosis Preserved liver function with precipitating factors (splenectomy, surgical portosystemic shunting, TIPS dysfunction, thrombophilia) Advanced disease in the absence of obvious precipitating factors (...) or progressing over a few days. 7,33,34 The abdomen might be moderately distended by ileus, but without any other features of intestinal obstruction. There is no guard- ing, except when an in?ammatory focus is the cause for PVT or when PVT is complicated with intestinal infarc- tion. The contrast between severity of pain and the ab- sence of peritoneal signs has long been regarded as suggestive of mesenteric venous thrombosis in the differ- ential diagnosis of peritonitis. 33,35 Partial thrombosis might

2009 American Association for the Study of Liver Diseases

178. Clinicopathological profile and surgical treatment of abdominal tuberculosis: a single centre experience in northwestern Tanzania. (PubMed)

abdominal tuberculosis. A total of 127 (49.6%) patients presented with intestinal obstruction, 106 (41.4%) with peritonitis, 17 (6.6%) with abdominal masses and 6 (2.3%) patients with multiple fistulae in ano. Forty-eight (18.8%) patients were HIV positive. A total of 212 (82.8%) patients underwent surgical treatment for abdominal tuberculosis. Bands /adhesions (58.5%) were the most common operative findings. Ileo-caecal region was the most common bowel involved in 122 (57.5%) patients. Release (...) generally poor as only 37.5% of patients were available for follow up at twelve months after discharge.Abdominal tuberculosis constitutes a major public health problem in our environment and presents a diagnostic challenge requiring a high index of clinical suspicion. Early diagnosis, early anti-tuberculous therapy and surgical treatment of the associated complications are essential for survival.

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2013 BMC Infectious Diseases

179. Partial characterization of a factor extracted from sensitized lymphocytes that inhibits the growth of Mycobacterium tuberculosis within macrophages in vitro. (PubMed)

Partial characterization of a factor extracted from sensitized lymphocytes that inhibits the growth of Mycobacterium tuberculosis within macrophages in vitro. Spleen lymphocytes of BCG-immunized mice contain a soluble factor that inhibits in vitro the growth of the H37Rv strain of Mycobacterium tuberculosis within normal peritoneal macrophages. The water-soluble extracts of sensitized lymphocytes, disrupted by freezing and thawing, although less active than the corresponding viable cells (...) lymphocytes did not affect BCG grown in vitro, and on repeated treatments of tuberculous mice they led to a negligible protection against pulmonary tuberculosis. Preliminary observations seem to indicate that other soluble factors in lymphocytes of BCG-sensitized mice have the capacity to potentiate in vitro the phagocytic activity of normal macrophages.

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1976 Infection and immunity

180. Miliary Crohn's disease. (PubMed)

Miliary Crohn's disease. 6019991 1967 05 02 2018 11 13 0017-5749 8 1 1967 Feb Gut Gut Miliary Crohn's disease. 4-7 Heaton K W KW McCarthy C F CF Horton R E RE Cornes J S JS Read A E AE eng Journal Article England Gut 2985108R 0017-5749 AIM IM Adolescent Crohn Disease diagnosis pathology surgery Diagnosis, Differential Female Humans Male Middle Aged Peritonitis, Tuberculous diagnosis Tuberculosis, Miliary diagnosis 1967 2 1 1967 2 1 0 1 1967 2 1 0 0 ppublish 6019991 PMC1552444 Gut. 1964 Dec;5

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1967 Gut

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