A 47-year-old man with cirrhosis secondary to alcoholic liver disease is brought to the emergency department by his care provider because of mental status changes. He has a history of hepatic encephalopathy and ascites but no history of gastrointestinal bleeding. His medications are furosemide, spironolactone, and lactulose. He has had confusion and somnolence for the past 3 days. On physical examination, the patient is afebrile, with a temperature of 99° F (37.2° C); pulse, 90 beats/min; respirations, 20 breaths/min; and blood pressure, 100/60 mm Hg. He is somnolent and oriented only to person.
Lungs are clear to auscultation. The abdomen is distended, with shifting dullness and bulging flanks; he has active bowel sounds and no tenderness on palpation. Stool is guaiac negative. Peripheral WBC is 9,400/mm3; hematocrit, 33%; platelets, 93,000/mm3. Peritoneal fluid reveals a WBC of 200/mm3 with 80% polymorphonuclear leukocytes (PMNs). Gram stain of ascitic fluid reveals no organisms.
Which of the following makes the diagnosis of spontaneous bacterial peritonitis (SBP) unlikely?
A. Absence of fever
B. Absence of elevated peripheral WBCs
C. Absence of abdominal pain or tenderness on examination
D. Gram stain of ascitic fluid revealing no organisms
E. PMN count in the ascitic fluid < 250 cells/mm3
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5 comments:
answer is e.
E
E
e
how could one have peritonitis in view of non tendor abdomen and good bowl sounds . first thing to happen in peritonitis is p ileus. so clinically what ever ur cell counts is it can never be SBP. answer is C
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