{"presentation":{"slides":[{"elements":[{"x":23.965141612200437,"y":12.958963282937365,"width":46.62309368191721,"height":79.91360691144709,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b25a022a177.png","mime":"image\/png","copyright":{"license":"U"},"width":607,"height":527}},"subContentId":"c0c6123f-045a-4896-8cba-68a054fd5b23","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":38.12636165577342,"y":60.47516198704104,"width":18.51851851851852,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Presumptive TB <\/span><\/span><\/p>\n"},"subContentId":"09bf8004-d266-4418-b5ad-341135a71b9b","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":41.394335511982575,"y":8.639308855291576,"width":16.33986928104575,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Clinical suspicion<\/p>\n"},"subContentId":"950d315c-db43-44f1-983c-15a2fcc0ad4a","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":13.071895424836601,"y":84.23326133909288,"width":10.893246187363834,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Risk factors <\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"49f5c12e-b552-4f13-8dbd-5fe7b89d3903"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":71.89542483660131,"y":84.23326133909288,"width":20.697167755991288,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Pulmonary involvement <\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"a85266d9-e7c7-4eb2-a550-4008a6b30059"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":4.319654427645788,"width":19.607843137254903,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Investigations<\/strong><\/span><\/p>\n"},"subContentId":"31ce4d27-d549-48b2-af3f-46885a669179","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":12.958963282937365,"width":91.50326797385621,"height":79.91360691144709,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

All cases of presumptive peritoneal TB must undergo:<\/p>\n\n

\n\t
Ancillary blood tests: <\/span><\/strong><\/li>\n<\/ul>\n\n
\n\t
CBC with peripheral smear: Normocytic normochromic anemia (of chronic disease), thrombocytosis, relative monocytosis<\/li>\n\t
ESR (raised)<\/li>\n\t
Baseline LFT, KFT<\/li>\n<\/ol>\n\n
\n\t
Chest X ray<\/strong><\/span>- to look for current or past evidence of Pulmonary TB<\/li>\n\t
HIV testing<\/strong><\/span>- greater likelihood of dissemination, EPTB and MDR-TB<\/li>\n\t
USG abdomen <\/strong><\/span><\/li>\n\t
Ascitic fluid analysis <\/strong><\/span><\/li>\n<\/ul>\n"},"subContentId":"43cd1217-dd99-4333-ae53-31aeebbf2ffe","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":71.89542483660131,"y":90.71274298056156,"width":25.05446623093682,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Index TB guidelines for EPTB in India- 2016<\/span><\/p>\n"},"subContentId":"f66b98ee-5d8d-46f0-8a1a-8b9bc60a7105","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":4.325269978401728,"width":50.10893246187364,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Diagnostic algorithm of Peritoneal tuberculosis <\/span><\/span><\/strong><\/span><\/p>\n"},"subContentId":"172edb83-4407-412f-9f4e-31ce777a8b1d","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":12.958963282937365,"width":86.60130718954248,"height":84.23326133909288,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b25c6d61c85.png","mime":"image\/png","copyright":{"license":"U"},"width":1910,"height":941}},"subContentId":"f2290a50-af1d-4a75-9858-d8edbd63e9f1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":92.5925925925926,"y":90.71274298056156,"width":4.357298474945534,"height":8.639308855291576,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b25c9d91007.png","mime":"image\/png","copyright":{"license":"U"},"width":128,"height":128}},"subContentId":"927880ea-ea5a-49bd-90b1-a19b3eb66035","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":6.479481641468682,"width":91.83006535947713,"height":84.23326133909288,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b25cbd2215b.png","mime":"image\/png","copyright":{"license":"U"},"width":1967,"height":915}},"subContentId":"2b9f6bc1-3079-41c5-ba20-4641d034138a","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":92.5925925925926,"y":90.71274298056154,"width":4.357298474945534,"height":8.639308855291576,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b25c9d91007.png","mime":"image\/png","copyright":{"license":"U"},"width":128,"height":128}},"metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"4487a0a4-5c24-4d5d-b5a2-fff86e3b2332"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.446623093681917,"y":4.319654427645788,"width":85.94771241830065,"height":90.71274298056156,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b25cf2e2b4c.png","mime":"image\/png","copyright":{"license":"U"},"width":1691,"height":903}},"subContentId":"119725d3-e2a4-4e17-90b2-c6f622e07629","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":92.5925925925926,"y":90.71274298056154,"width":4.357298474945534,"height":8.639308855291576,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b25c9d91007.png","mime":"image\/png","copyright":{"license":"U"},"width":128,"height":128}},"metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"2628c84f-b334-4c98-b0af-b8e4524970f6"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":4.325269978401728,"width":34.85838779956427,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
USG in Peritoneal tuberculosis <\/strong><\/span><\/p>\n"},"subContentId":"d765ec05-92ab-4822-8f32-ca12fde344bd","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":15.11879049676026,"width":47.930283224400874,"height":62.634989200863934,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Ultrasound abdomen in typical cases can show:<\/p>\n\n
\n\t
\n\t
Free or loculated fluid in the abdomen, in which fine septations may be seen (MC differential- malignant ascites)<\/p>\n\t<\/li>\n\t
\n\t
Enlarged lymph nodes (mesenteric, retro-peritoneal) which, if hypoechoic, increase the likelihood<\/p>\n\t<\/li>\n\t
\n\t
Diffuse peritoneal and omental thickening<\/p>\n\t<\/li>\n\t
\n\t
Inter-loop ascites (club sandwich sign)<\/strong><\/span><\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"0091abf1-6e91-4b45-a8ce-824ed626f810","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":49.016775599128536,"y":84.31771058315334,"width":49.01960784313726,"height":12.958963282937365,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Sharma MP<\/a><\/span><\/span> et al. Abdominal tuberculosis. Indian J Med Res.<\/a> 2004 Oct;120(4):305-15<\/span><\/span><\/span><\/span><\/span>
\nIndex TB guidelines for EPTB in India- 2016<\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"8f0378e2-51f1-4cb0-8aa5-8765d52a703d","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":56.64488017429194,"y":12.958963282937365,"width":36.9281045751634,"height":64.79481641468682,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b25eb26ba2d.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":276,"height":246}},"subContentId":"1b97174b-9fa8-44bb-aaac-30208ac08c8b","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":4.325269978401728,"width":34.85838779956427,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
USG in Peritoneal tuberculosis <\/strong><\/span><\/p>\n"},"subContentId":"fdcb8799-8ef0-4bca-a362-bb5bf6f29489","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":3.2679738562091503,"y":10.799136069114471,"width":90.41394335511983,"height":45.35637149028078,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
At times, a loculated mass may be seen, showing an encapsulated fluid collection with thick septa (MC differential\uf0e0 tubo-ovarian mass)<\/p>\n\t<\/li>\n\t
\n\t
Bowel wall thickening (concomitant intestinal disease)<\/p>\n\t<\/li>\n\t
\n\t
Clumping of bowel loops to each other or on abdominal wall<\/p>\n\t<\/li>\n\t
\n\t
It is essential to rule out <\/strong><\/span>other causes like chronic liver disease and tubo-ovarian masses<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"1098d551-8eed-455b-b316-1ca9fbab036b","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":49.016775599128536,"y":84.31771058315334,"width":49.01960784313726,"height":12.958963282937365,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Sharma MP<\/a><\/span><\/span> et al. Abdominal tuberculosis. Indian J Med Res.<\/a> 2004 Oct;120(4):305-15<\/span><\/span><\/span><\/span><\/span>
\nIndex TB guidelines for EPTB in India- 2016<\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"47893eb4-e037-47fa-8d84-7b63485ebac7","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":4.325269978401728,"width":34.85838779956427,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Ascitic fluid analysis <\/strong><\/span><\/p>\n"},"subContentId":"d54e3a01-c626-4d1d-86f9-b861cea13e25","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":12.958963282937365,"width":90.41394335511983,"height":75.5939524838013,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Ascitic fluid should be sent for:<\/p>\n\n
\n\t
\n\t
Cytology <\/p>\n\t<\/li>\n\t
\n\t
Biochemistry (protein, albumin, sugar)<\/p>\n\t<\/li>\n\t
\n\t
ADA <\/strong><\/span><\/p>\n\t<\/li>\n\t
\n\t
Microscopy for AFB<\/p>\n\t<\/li>\n\t
\n\t
Culture for TB (liquid\/solid)<\/p>\n\t<\/li>\n\t
\n\t
GeneXpert (whenever feasible)<\/p>\n\t<\/li>\n\t
\n\t
Gram stain and culture for bacterial\/fungal organism (case to case basis)<\/p>\n\t<\/li>\n\t
\n\t
Malignant cytology (case to case basis, at least 3 samples if high suspicion)<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"a9b2eb17-9a4a-4ae5-a1e8-a83fa3694888","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":4.325269978401728,"width":34.85838779956427,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Ascitic fluid analysis <\/strong><\/span><\/p>\n"},"subContentId":"3e5aca7f-0359-4bb1-ab91-8085f290820a","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":15.11879049676026,"width":89.32461873638344,"height":62.634989200863934,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Ascitic fluid analysis can show:<\/p>\n\n
\n\t
\n\t
Straw coloured fluid<\/p>\n\t<\/li>\n\t
\n\t
Cytology showing raised TLC with lymphocytic predominance<\/p>\n\t<\/li>\n\t
\n\t
Low SAAG (<1.1) <\/p>\n\t<\/li>\n\t
\n\t
High protein (>=2.5 g\/dL)<\/p>\n\t<\/li>\n\t
\n\t
ADA > 39<\/strong><\/span> (sensitivity and specificity 93% and 94%)
\n\t(In cirrhotics, sensitivity is poor and ADA can be low, as they mount a weak inflammatory response)<\/p>\n\t<\/li>\n\t
\n\t
Microscopy for AFB (sensitivity <2%)<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"f134c7a5-a560-4efe-8d89-ba07d3892e91","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":44.659477124183006,"y":75.66997840172786,"width":53.37690631808279,"height":22.03023758099352,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Sharma MP<\/a><\/span><\/span> et al. Abdominal tuberculosis. Indian J Med Res.<\/a> 2004 Oct;120(4):305-15
\nIndex TB guidelines for EPTB in India- 2016<\/span><\/span>
\n Riquelme<\/a><\/span><\/span> A<\/a><\/span><\/span>. <\/span><\/span>Value of adenosine deaminase (ADA) in ascitic fluid for the diagnosis of tuberculous peritonitis: a meta-analysis. <\/span><\/span>J Clin Gastroenterol.<\/a><\/span><\/span> 2006 Sep;40(8):705-10.<\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"bb49e7d8-b841-41e2-849a-2c8ddf3d95ad","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":6.479481641468682,"width":34.85838779956427,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Ascitic fluid analysis <\/strong><\/span><\/p>\n"},"subContentId":"a301cd44-b61e-429e-96b7-7fc47f30e5cb","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":3.2679738562091503,"y":12.958963282937365,"width":88.23529411764706,"height":60.47516198704104,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
TB culture (solid and liquid) -> Sensitivity ~20%<\/li>\n\t
\n\t
PCR based methods like Gene Xpert were not recommended in the Index TB guidelines on EPTB<\/p>\n\t<\/li>\n\t
\n\t
However, a Cochrane meta-analysis (2018) showed sensitivity of GeneXpert to be 59% in peritoneal fluid<\/p>\n\t<\/li>\n\t
\n\t
Sending complete<\/strong><\/span> panel comprising AFB, TB culture and GeneXpert increases the overall diagnostic yield<\/span><\/strong><\/p>\n\t<\/li>\n\t
\n\t
Sending ascitic fluid for GeneXpert is currently a conditional recommendation, to be used as a probable test <\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"18bc4ba5-0ab6-4027-bb59-2b8eca59204f","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":44.659477124183006,"y":75.66997840172786,"width":53.37690631808279,"height":21.598272138228943,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Kohli M et al. Xpert\u00ae MTB\/RIF assay for extrapulmonary tuberculosis and rifampicin resistance. Cochrane Database of Systematic Reviews 2018, Issue 8
\nDebi U et al. Abdominal tuberculosis of the gastrointestinal tract: revisited. World J Gastroenterol 2014;20:14831-40<\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"8482c51e-d191-40e6-a8eb-b0d5aef55295","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":70.80326797385621,"y":75.66997840172786,"width":25.05446623093682,"height":19.43844492440605,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Kohli M et al. Xpert\u00ae MTB\/RIF assay for extrapulmonary tuberculosis and rifampicin resistance. Cochrane Database of Systematic Reviews 2018, Issue 8<\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"8ae84e05-051a-4bd4-8e31-b83fa69ddcb5","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.446623093681917,"y":2.159827213822894,"width":62.41830065359477,"height":95.03239740820734,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b264a7f224b.png","mime":"image\/png","copyright":{"license":"U"},"width":873,"height":672}},"subContentId":"789e8ba6-a415-4f1b-9347-e82796c62b93","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":6.479481641468682,"width":34.85838779956427,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
CT in peritoneal tuberculosis <\/strong><\/span><\/p>\n"},"subContentId":"44ad91f1-f329-472c-bf45-5dae26b41a57","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":15.11879049676026,"width":89.32461873638344,"height":51.83585313174946,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
CECT abdomen is sufficient for peritoneal TB, and in typical cases can show:<\/p>\n\n
\n\t
\n\t
Ascitic fluid with high attenuation value (more grey as compared to urine in bladder)<\/p>\n\t<\/li>\n\t
\n\t
Peritoneum smoothly thickened with enhancement<\/strong><\/span>. Nodular implants and irregular peritoneal thickening suggest carcinomatosis<\/p>\n\t<\/li>\n\t
\n\t
Matting of loops, fibrous adhesions, omental caking\/masses and abdominal cocoon formation (small bowel loops matted together, encased by an enhancing memebrane)<\/p>\n\t<\/li>\n\t
\n\t
Thickened mesentery with mesenteric lymph nodes which usually have hypodense center (necrotic<\/span><\/strong>)<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"74433ff9-bcf9-47be-82bc-687212369997","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":43.57015250544662,"y":82.15788336933045,"width":53.37690631808279,"height":17.278617710583152,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Sharma MP<\/a><\/span><\/span> et al. Abdominal tuberculosis. Indian J Med Res.<\/a> 2004 Oct;120(4):305-15<\/span>
\n Sanai FM<\/a> et al. Systematic review: tuberculous peritonitis--presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther.<\/a> 2005 Oct 15;22(8):685-700<\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"39e487c1-30e0-4d3b-856b-c222f2f188f7","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":6.479481641468682,"width":34.85838779956427,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
CECT: Wet ascitic type <\/strong><\/span><\/p>\n"},"subContentId":"4c9cfe19-e245-441d-9e15-9ebec892a83a","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":23.96230936819172,"y":88.73282937365012,"width":56.64488017429194,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Gross ascites: Ascitic fluid separating the leaves of the mesentery<\/p>\n"},"subContentId":"eacd30df-7476-4f1a-85f9-1533f79e1bfc","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":25.05446623093682,"y":15.11879049676026,"width":53.37690631808279,"height":70.84233261339094,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b2686174e07.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":1086,"height":732}},"subContentId":"725cd3de-6542-479d-9c7f-d2585ae6faa0","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":6.490734341252699,"width":47.930283224400874,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
CECT: Loculated\/encysted type <\/strong><\/span><\/p>\n"},"subContentId":"c045e3b0-bcf5-49fa-88b7-adb58633f5ee","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":58.82352941176471,"y":56.15550755939525,"width":31.59041394335512,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Thickening and enhancement of parietal peritoneum <\/span><\/p>\n"},"subContentId":"ad8dc1f8-d30a-43ef-ac35-1695cfd60cdd","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":15.11879049676026,"width":78.64923747276688,"height":77.7537796976242,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b26918a0658.png","mime":"image\/png","copyright":{"license":"U"},"width":1868,"height":936}},"subContentId":"019cfcac-dc02-491e-a10f-45a891075dbd","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":54.46623093681917,"y":69.11447084233261,"width":42.48366013071895,"height":28.077753779697623,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Figure (a-e): CECT images of abdomen in axial (a-c) and coronal (d,e) plane show a loculated collection (star) and uniform thickening and enhancement of parietal peritoneum (thin arrow). There is associated gross thickening of greater omentum (arrow-head) (omental caking)<\/span><\/p>\n"},"subContentId":"1531470a-0993-4c6c-b93f-2b0a93ba22d9","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":6.490734341252699,"width":47.930283224400874,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
USG guided FNAC <\/strong><\/span><\/p>\n"},"subContentId":"8e4e29e7-eb07-493b-a5d5-ca1a46c465f5","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.3544662309368185,"y":17.312354211663067,"width":90.41394335511983,"height":43.196544276457885,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
USG-guided FNAC or core biopsy:<\/p>\n\n
\n\t
\n\t
Few select cases which remain a diagnostic dilemma (radiology not typical\/ascites absent\/ascitic fluid analysis not suggestive\/no response to trial of ATT till 4-8 weeks) may require an additional FNA or core biopsy from peritoneal or omental thickening or from the intra-abdominal lymph nodes<\/p>\n\t<\/li>\n\t
\n\t
Specimens should be sent for histopathology (formalin), microscopy for AFB, culture for M. tb and GeneXpert (all 3 in sterile saline<\/span><\/strong>)<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"0c2612ee-6ccd-4f7a-b9bc-a4facf96d188","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":6.490734341252699,"width":47.930283224400874,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Diagnostic Laparoscopy<\/strong><\/span><\/p>\n"},"subContentId":"9506ce75-3503-4002-a0c9-1dbd5fb364b8","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":17.278617710583152,"width":90.41394335511983,"height":53.99568034557235,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
When the diagnosis is still doubtful after a battery of investigations, visual appearance on laparoscopy can be highly suggestive of peritoneal Tuberculosis<\/p>\n\n
Typical appearances include:<\/p>\n\n
\n\t
\n\t
Thickened peritoneum with or without tubercles: multiple, yellowish white, uniform sized (~ 4\u20135mm) tubercles diffusely distributed on the parietal peritoneum<\/p>\n\t<\/li>\n\t
\n\t
The peritoneum is hyperaemic and lacks its usual shiny lustre<\/p>\n\t<\/li>\n\t
\n\t
The omentum, liver and spleen can also be studded with tubercles<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"0659489b-59dc-49f4-b638-c88984f6e80c","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":69.71677559912854,"y":90.71274298056156,"width":25.05446623093682,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Index TB guidelines for EPTB in India- 2016<\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"5a89affb-da29-4a68-af7b-1958061c6db2","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.3544662309368185,"y":6.490734341252699,"width":47.930283224400874,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Diagnostic Laparoscopy<\/strong><\/span><\/p>\n"},"subContentId":"7b100728-225f-4dc6-a14f-bd56600f4d5f","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":3.2679738562091503,"y":12.958963282937365,"width":90.41394335511983,"height":53.99568034557235,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
Fibro-adhesive peritonitis with markedly thickened peritoneum and multiple thick adhesions fixing the viscera<\/p>\n\t<\/li>\n\t
\n\t
Targeted diagnostic sampling at laparoscopy improves the yield, with sensitivity of visual appearance approaching 93% and histopathological yield upto 98%<\/p>\n\t<\/li>\n\t
\n\t
Tissue must be sent for microscopy and culture (in sterile saline<\/strong>) for M. tb, GeneXpert and histopathology<\/p>\n\t<\/li>\n\t
\n\t
Laparoscopy is not<\/strong> routinely recommended due to the high cost and invasive nature of the procedure<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"d11a0ca9-2499-40c5-8515-5435f4cc5fbb","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":69.71677559912854,"y":90.71274298056156,"width":25.05446623093682,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Index TB guidelines for EPTB in India- 2016<\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"1dfafb58-74a5-44ad-bf95-388fc974824c","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}}],"keywordListEnabled":true,"globalBackgroundSelector":{},"keywordListAlwaysShow":false,"keywordListAutoHide":false,"keywordListOpacity":90},"override":{"activeSurface":false,"hideSummarySlide":false,"summarySlideSolutionButton":true,"summarySlideRetryButton":true,"enablePrintButton":false,"social":{"showFacebookShare":false,"facebookShare":{"url":"@currentpageurl","quote":"I scored @score out of @maxScore on a task at @currentpageurl."},"showTwitterShare":false,"twitterShare":{"statement":"I scored @score out of @maxScore on a task at @currentpageurl.","url":"@currentpageurl","hashtags":"h5p, course"},"showGoogleShare":false,"googleShareUrl":"@currentpageurl"}},"l10n":{"slide":"Slide","score":"Score","yourScore":"Your Score","maxScore":"Max Score","total":"Total","totalScore":"Total Score","showSolutions":"Show solutions","retry":"Retry","exportAnswers":"Export text","hideKeywords":"Hide sidebar navigation menu","showKeywords":"Show sidebar navigation menu","fullscreen":"Fullscreen","exitFullscreen":"Exit fullscreen","prevSlide":"Previous slide","nextSlide":"Next slide","currentSlide":"Current slide","lastSlide":"Last slide","solutionModeTitle":"Exit solution mode","solutionModeText":"Solution Mode","summaryMultipleTaskText":"Multiple tasks","scoreMessage":"You achieved:","shareFacebook":"Share on Facebook","shareTwitter":"Share on Twitter","shareGoogle":"Share on Google+","summary":"Summary","solutionsButtonTitle":"Show comments","printTitle":"Print","printIngress":"How would you like to print this presentation?","printAllSlides":"Print all slides","printCurrentSlide":"Print current slide","noTitle":"No title","accessibilitySlideNavigationExplanation":"Use left and right arrow to change slide in that direction whenever canvas is selected.","accessibilityCanvasLabel":"Presentation canvas. Use left and right arrow to move between slides.","accessibilityProgressBarLabel":"Choose slide to display","containsNotCompleted":"@slideName contains not completed interaction","containsCompleted":"@slideName contains completed interaction","slideCount":"Slide @index of @total","containsOnlyCorrect":"@slideName only has correct answers","containsIncorrectAnswers":"@slideName has incorrect answers","shareResult":"Share Result","accessibilityTotalScore":"You got @score of @maxScore points in total","accessibilityEnteredFullscreen":"Entered fullscreen","accessibilityExitedFullscreen":"Exited fullscreen","confirmDialogHeader":"Submit your answers","confirmDialogText":"This will submit your results, do you want to continue?","confirmDialogConfirmText":"Submit and see results","slideshowNavigationLabel":"Slideshow navigation"}}

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Diagnosis of Peritoneal TB

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Diagnosis of Peritoneal TB

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