{"presentation":{"slides":[{"elements":[{"x":4.3544662309368185,"y":6.490734341252699,"width":21.78649237472767,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Case vignette (1)<\/strong><\/span><\/p>\n"},"subContentId":"30f2e5ed-5ace-4234-8e11-e2a955d38e61","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":45.35637149028078,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Mr. A, 51-year-old man from Patna, Bihar, known case of type 2 DM, presents to the Medicine OPD with:<\/p>\n\n

\n\t
\n\t
Progressive abdominal distension x 4 months<\/p>\n\t<\/li>\n\t
\n\t
Evening rise of temperature x 4 months<\/p>\n\t<\/li>\n\t
\n\t
Loss of appetite x 4 months<\/p>\n\t<\/li>\n\t
\n\t
Dull aching abdominal pain x 3 months<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"30a14f73-691a-4b4e-b119-3f7a15554ec2","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":34.85838779956427,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
History and clinical examination <\/strong><\/span><\/p>\n"},"subContentId":"57c3efff-541f-425c-a4c5-2caf919ffb75","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":62.634989200863934,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
No past history of abdominal distension, jaundice, altered behaviour, blood in vomitus or black tarry stools<\/li>\n\t
No past history of TB and no history of contact with a case of TB<\/li>\n\t
Clinical examination <\/li>\n<\/ul>\n\n
\n\t
Pallor<\/li>\n\t
Free fluid in the abdomen (dullness on percussion)<\/li>\n<\/ol>\n\n
\n\t
There were no stigmata of chronic liver disease<\/li>\n<\/ul>\n"},"subContentId":"74b56485-3f7c-428a-8aa1-6acfd677561f","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":"
Differential diagnosis <\/strong><\/span><\/p>\n"},"subContentId":"5d04559b-2506-41a2-935c-31d9eef33be4","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":62.634989200863934,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
Primary peritoneal disease<\/li>\n<\/ul>\n\n
\n\t
Tuberculosis<\/li>\n\t
Peritoneal carcinomatosis<\/li>\n<\/ol>\n\n
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Chronic liver disease (cirrhosis) with decompensation<\/li>\n\t
GI malignancy<\/li>\n<\/ul>\n"},"subContentId":"646c6132-d14e-4452-846b-2bd2b9861a4f","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":"
Approaching our case <\/strong><\/span><\/p>\n"},"subContentId":"629f3f74-93fb-471a-883b-f5c5ed629a06","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":62.634989200863934,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Mr. A, 51-year-old man from Patna, Bihar, known case of type 2 DM, presents to the Medicine OPD with:<\/p>\n\n
\n\t
\n\t
Progressive abdominal distension x 4 months<\/p>\n\t<\/li>\n\t
\n\t
Evening rise of temperature x 4 months<\/p>\n\t<\/li>\n\t
\n\t
Loss of appetite x 4 months<\/p>\n\t<\/li>\n\t
\n\t
Dull aching abdominal pain x 3 months<\/p>\n\t<\/li>\n<\/ul>\n\n
The patient underwent ancillary blood tests, CXR, HIV testing, an ultrasound abdomen and diagnostic paracentesis<\/p>\n"},"subContentId":"e83d0fdb-f197-4ae6-965e-df77aed149f4","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":"
Our patient (Mr. A) <\/strong><\/span><\/p>\n"},"subContentId":"153af20c-c0e4-458f-8448-3a3801caae8b","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":69.11447084233261,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
CBC revealed normocytic, normochromic anemia<\/strong><\/span> (Hb-9.2g\/dL) with TLC 5600\/uL and platelet count of 560,000\/uL. His ESR was<\/span><\/strong> 60mm\/h<\/strong><\/span><\/p>\n\t<\/li>\n\t
\n\t
LFT revealed an albumin of 3.5g\/dL, T. bilirubin- 0.3, OT\/PT\/ALP- 35\/26\/184<\/p>\n\t<\/li>\n\t
\n\t
His blood glucose values (F\/PP) were 182mg\/dL and 261mg\/dL with HbA1c 8.4<\/p>\n\t<\/li>\n\t
\n\t
KFT was within normal limits <\/p>\n\t<\/li>\n\t
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HIV test was negative<\/p>\n\t<\/li>\n\t
\n\t
Chest X ray was normal<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"7011dc9b-79bb-45da-92d3-8f136b789663","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":"
Our patient <\/strong><\/span><\/p>\n"},"subContentId":"ea58f457-a995-462e-8db3-dc8f31b3e97e","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":17.278617710583152,"width":89.32461873638344,"height":56.15550755939525,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Ultrasound of the abdomen, done before the paracentesis, showed:<\/p>\n\n
\n\t
\n\t
Mild hepatomegaly with normal echotexture<\/p>\n\t<\/li>\n\t
\n\t
Bowel loops were normal with no matting <\/p>\n\t<\/li>\n\t
\n\t
There was diffuse peritoneal and omental thickening<\/p>\n\t<\/li>\n\t
\n\t
Moderate ascites without septations or internal echoes<\/p>\n\t<\/li>\n\t
\n\t
Enlarged retroperitoneal lymph nodes<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"6740c6f7-6d9b-4986-b64d-38bdf37db040","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":"
Our patient <\/strong><\/span><\/p>\n"},"subContentId":"19b77008-06c2-49d7-a22c-2c89655046ed","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":17.278617710583152,"width":89.32461873638344,"height":66.95464362850971,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Diagnostic ascitic tap revealed:<\/p>\n\n
\n\t
\n\t
AF TLC of 480 (P20 L80)<\/p>\n\t<\/li>\n\t
\n\t
AF protein of 6g\/dL<\/p>\n\t<\/li>\n\t
\n\t
SAAG was calculated to be 0.8<\/p>\n\t<\/li>\n\t
\n\t
Gram stain did not show any organism and AFB was negative<\/p>\n\t<\/li>\n\t
\n\t
Malignant cytology negative<\/p>\n\t<\/li>\n\t
\n\t
GeneXpert was negative and TB culture was awaited<\/p>\n\t<\/li>\n\t
\n\t
ADA was 44 IU\/L<\/strong><\/span><\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"39cfe48c-4bdb-47da-ae98-65adf25033d9","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":"
Further management <\/strong><\/span><\/p>\n"},"subContentId":"e5d21bb7-9c1c-4885-8928-5be055a008e2","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.4409477124183,"y":15.17503239740821,"width":89.32461873638344,"height":47.51619870410367,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
With a background of:<\/p>\n\n
\n\t
Low SAAG, highly proteinaceous ascites with AF TLC 480 (P20 L80)<\/li>\n\t
Ascitic fluid ADA of 44 IU\/L<\/li>\n<\/ul>\n\n
It was decided to start the patient on therapeutic trial of 1st line ATT (clinically diagnosed case)<\/p>\n\n
The patient was monitored at 2 months and he showed resolution of all symptoms<\/p>\n"},"subContentId":"565bfdb2-6c52-4681-96ea-c79e5b6337ab","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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Peritoneal TB Clinical Scenarios

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Peritoneal TB Clinical Scenarios

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