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Tuberculous Peritonitis

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161. 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

162. Abdominal Hernias (Treatment)

hernia is generally safe, failure to reduce is not infrequent and mandates prompt exploration. Signs of inflammation or obstruction should rule out attempts at reduction. Difficult reduction should promptly be followed by repair. Unintentional reduction of the intestine with vascular compromise leads to perforation and peritonitis with high morbidity and mortality. En masse reduction after vigorous attempts at reducing a hernia with a small fibrous neck results in ongoing compromise of the entrapped (...) (particularly the fallopian tube and ovary) may not be reducible into the peritoneum. The walls must then be inspected for a sliding component. To repair a sliding hernia, the sac is ligated distal to the fallopian tube and divided. The proximal sac is ligated and then invaginated into the peritoneal cavity. A purse-string suture inside the opened hernia sac may be used to aid in visualization during sac closure. The internal ring is closed with sutures from the transversalis fascia to the iliopubic tract

2014 eMedicine Surgery

163. Vertebral Fracture (Overview)

in hemorrhagic shock. A bedside ultrasound evaluation is a noninvasive screen for free fluid in the peritoneum. The more invasive peritoneal tap and lavage is the classic method of assessment for free fluid. Both types of shock require aggressive fluid and hemodynamic resuscitation. Spinal shock refers to the temporary loss of spinal reflex activity that occurs below a total or near-total spinal cord injury. It initially results in hyporeflexia and flaccid paralysis. With time, the descending inhibitory (...) -68. . Laheri VJ, Badhe NP, Dewnany GT. Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine. Spinal Cord . 2001 Aug. 39(8):429-36. . Larson JL. Injuries to the spine. In: Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergency Medicine: A Comprehensive Study Guide. 5th ed . New York, NY: McGraw-Hill. 2000: 1792-1800. Lowe TG, Tahernia AD. Unilateral transforaminal posterior lumbar interbody fusion. Clin Orthop

2014 eMedicine Surgery

164. Vertebral Fracture (Diagnosis)

in hemorrhagic shock. A bedside ultrasound evaluation is a noninvasive screen for free fluid in the peritoneum. The more invasive peritoneal tap and lavage is the classic method of assessment for free fluid. Both types of shock require aggressive fluid and hemodynamic resuscitation. Spinal shock refers to the temporary loss of spinal reflex activity that occurs below a total or near-total spinal cord injury. It initially results in hyporeflexia and flaccid paralysis. With time, the descending inhibitory (...) -68. . Laheri VJ, Badhe NP, Dewnany GT. Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine. Spinal Cord . 2001 Aug. 39(8):429-36. . Larson JL. Injuries to the spine. In: Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergency Medicine: A Comprehensive Study Guide. 5th ed . New York, NY: McGraw-Hill. 2000: 1792-1800. Lowe TG, Tahernia AD. Unilateral transforaminal posterior lumbar interbody fusion. Clin Orthop

2014 eMedicine Surgery

165. Tuberculosis (Treatment)

, 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

166. 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

167. 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

168. Tuberculosis (Follow-up)

, 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

169. 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

170. 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

171. Mesenteric Adenitis

28. 12(24):3933-5. . Patlas MN, Alabousi A, Scaglione M, Romano L, Soto JA. Cross-sectional imaging of nontraumatic peritoneal and mesenteric emergencies. Can Assoc Radiol J . 2013 May. 64(2):148-53. . Benetti C, Conficconi E, Hamitaga F, Wyttenbach M, Lava SAG, Milani GP, et al. Course of acute nonspecific mesenteric lymphadenitis: single-center experience. Eur J Pediatr . 2018 Feb. 177 (2):243-246. . Gross I, Siedner-Weintraub Y, Stibbe S, Rekhtman D, Weiss D, Simanovsky N, et al (...) RG. Incidentally detected misty mesentery on CT: risk of malignancy correlates with mesenteric lymph node size. J Comput Assist Tomogr . 2012 Jan-Feb. 36(1):26-9. . Koning JL, Naheedy JH, Kruk PG. Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children. Pediatr Radiol . 2014 Aug. 44 (8):948-55. . Borgia G, Ciampi R, Nappa S, et al. Tuberculous mesenteric lymphadenitis clinically presenting as abdominal mass: CT and sonographic

2014 eMedicine Radiology

172. 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

173. 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

174. 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

175. 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

176. 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

177. 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

178. 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

179. Clinicopathological profile and surgical treatment of abdominal tuberculosis: a single centre experience in northwestern Tanzania. Full Text available with Trip Pro

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.

2013 BMC Infectious Diseases

180. CELLULAR REACTIONS TO POLYSACCHARIDES FROM TUBERCLE BACILLI AND FROM PNEUMOCOCCI Full Text available with Trip Pro

CELLULAR REACTIONS TO POLYSACCHARIDES FROM TUBERCLE BACILLI AND FROM PNEUMOCOCCI 1. Purified tuberculo-polysaccharides are relatively innocuous both to normal and to tuberculous guinea pigs. 2. Both tuberculo-polysaccharides and polysaccharides from pneumococci call larger numbers of leucocytes from the blood vessels than do saline and dextrose and trehalose. 3. The mechanisms controlling the delivery of lymphocytes and neutrophils into the blood stream are different. 4. Slight irritation (...) of the peritoneal lining slows the delivery of lymphocytes to the blood stream. 5. There are two phases in the reaction of the bone marrow to intraperitoneal injections. Correlated with the draining of neutrophils from vessels to tissues, owing to the presence of foreign materials in the latter, there is a draining of young neutrophils from the marrow into the sinuses of the marrow as these same materials reach the sinuses. The subsequent disintegration of the neutrophils extravasated into the tissues

1938 The Journal of experimental medicine

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