Familial mediterranean fever differential diagnosis: Difference between revisions

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{{Familial mediterranean fever}}
{{Familial mediterranean fever}}


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FMF must be differentiated from other causes of secondary peritonitis
 
{| style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;" cellspacing="0" cellpadding="4" border="2"
|+'''Differentiating FMF from other causes of peritonitis'''
! colspan="2" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Disease'''}}
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Prominent clinical findings'''}}
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Lab tests'''}}
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Tratment'''}}
|-
| rowspan="3" |'''Primary peritonitis'''
|'''[[Primary peritonitis|Spontaneous bacterial peritonitis]]'''
|
* Absence of GI [[perforation]], most closely associated with [[cirrhosis]] and [[Liver disease|advanced liver disease]].
* Presents with abrupt onset of [[fever]], [[abdominal pain]], [[distension]], and [[rebound tenderness]].
|
* Most have clinical and biochemical manifestations of advanced [[cirrhosis]] or [[nephrosis]] like [[leukocytosis]],[[hypoalbuminemia]],
* Prolonged [[prothrombin]] time. SAAG >1.1 g/dL, increased serum [[lactic acid]] level, or a decreased [[Ascites|ascitic fluid]] pH (< 7.31) supports the diagnosis. [[Gram staining]] reveals bacteria in only 25% of cases.
* Diagnosed by analysis of the [[Ascitic|ascitic fluid]] which reveals [[WBC]] > 500/ML, and [[PMN]] >250cells/ml.
* [[Culture medium|Culture]] of ascitic fluid inoculated immediately into [[blood culture]] media at the bedside usually reveals a single [[Enteric Bacilli|enteric organism]], most commonly ''[[Escherichia coli]]'', ''[[Klebsiella]]'', or [[streptococci]].
|
* Once diagnosed,it is treated with [[Ceftriaxone]].
|-
|'''[[Tuberculous peritonitis]]'''
|
* Seen in 0.5% of new cases of [[tuberculosis]] particularly in young women in endemic areas as a primary infection.
* Presents with [[abdominal pain]] and [[distension]], [[fever]], [[night sweats]], [[weight loss]], and altered bowel habits.
|
* [[Ascites]] is present in about half of cases. [[Abdominal mass]] may be felt in a third of cases. The [[peritoneal fluid]] is characterized by a [[protein]] concentration > 3 g/dL with < 1.1 g/dL SAAG and [[Lymphocyte|lymphocyte predominance]] of [[WBC]].
* Definitive diagnosis in 80% of cases is by culture. Most patients presenting acutely are diagnosed only by [[laparotomy]].
|
* Combination [[Antituberculosis|antituberculosis chemotherapy]] is preferred in chronic cases.
|-
|'''[[Continuous ambulatory peritoneal dialysis|Continuous Ambulatory Peritoneal Dialysis]]''' [[Continuous ambulatory peritoneal dialysis|('''CAPD peritonitis)''']]
|
* [[Peritonitis]] is one of the major complications of [[peritoneal dialysis]] & 72.6% occurred within the first six months of [[peritoneal dialysis]].
* Historically, [[coagulase-negative staphylococci]] were the most common cause of peritonitis in [[Continuous ambulatory peritoneal dialysis|CAPD]], presumably due to touch contamination or infection via the pericatheter route.
* Treatment for [[peritoneal dialysis]]-associated peritonitis consists of [[Antimicrobial drug|antimicrobial therapy]], in some cases catheter removal is also warranted.
* Additional therapies for [[Peritonitis|relapsing or recurrent peritonitis]] may include [[Fibrinolytic agent|fibrinolytic agents]] and [[peritoneal lavage]]. Most episodes of peritoneal dialysis-associated peritonitis resolve with outpatient [[Antibiotic|antibiotic treatment]].
|
* Majority of [[peritonitis]] cases are caused by [[bacteria]] (50%-due to [[Gram-positive bacteria|gram positive]] organisms, 15% to [[gram negative]] organisms,20% were culture negative.2% of cases are caused by [[fungi]], mostly [[Candida]] species. Polymicrobial infection in 4%.Exit-site infection was present in 13% and a [[peritoneal fluid]] leak in 3 % and [[M.tuberculosis]] 0.1%.
|
* [[Antibiotic|Initial empiric antibiotic coverage]] for peritoneal dialysis-associated peritonitis consists of coverage for [[gram-positive]] organisms (by [[vancomycin]] or a [[Cephalosporins|first-generation cephalosporin]]) and [[gram-negative]] organisms (by a [[cephalosporin|third-generation cephalosporin]] or an [[aminoglycoside]]). Subsequently, the regimen should be adjusted based on [[Culture medium|culture]] and [[sensitivity]] data. Cure rates are approximately 75%.
|-
| rowspan="2" |'''[[Secondary peritonitis]]'''
|'''Acute [[bacterial]] [[secondary peritonitis]]'''
|
* Occurs after perforating, penetrating, inflammatory, infectious, or [[ischemic]] injuries of the GI or GU tracts. Most often follows disruption of a hollow viscus?chemical peritonitis?bacterial peritonitis(polymicrobial, includes [[aerobic]] [[gram negative]] {[[E coli]], [[Klebsiella]], [[Enterobacter]], [[Proteus mirabilis]]} and gram positive { [[Enterococcus]], [[Streptococcus]]} and [[anaerobes]] {[[Bacteroides]], [[clostridia]]}).
* Presents with [[abdominal pain]], [[tenderness]], [[guarding]] or rigidity, [[distension]], free peritoneal air, and diminished [[bowel sounds]]. Signs that reflect irritation of the parietal peritoneum resulting [[ileus]]. Systemic findings include [[fever]], [[chills]] or [[rigors]], [[tachycardia]], [[sweating]], [[tachypnea]], [[restlessness]], [[dehydration]], [[oliguria]], [[disorientation]], and, ultimately, refractory [[shock]].  
|
|
* [[Peritoneal lavage]], [[Laparoscopy]] are the treatment of choice.
|-
|'''[[Biliary]] [[Secondary peritonitis|peritonitis]]'''
|
* Most often seen in cases of rupture of pathological [[gallbladder]] or [[bile duct]] or [[Cholangitis|cholangitic abscess]] or secondary to obstruction of the [[biliary tract]].
* Seen in alcoholic patients with [[ascites]].
|
|
|-
| colspan="2" |'''[[Peritonitis|Tertiary peritonitis]]'''
|
* Persistence or recurrence of [[Infection|intraabdominal infection]] following apparently adequate therapy of [[Peritonitis|primary or secondary peritonitis]].
* Associated with [[Mortality|high mortality]] due to multi organ dysfunction. It presents in a similar way as other [[peritonitis]] but is recognized as an adverse outcome with poor prognosis.
|
* [[Enterococcus]], [[Candida]], [[Staphylococcus epidermidis]], and [[Enterobacter]] being the most common organisms.
|
* Characterized by lack of response to appropriate surgical and [[antibiotic therapy]] due to disturbance in the hosts [[immune response]].
|-
| colspan="2" |'''[[Familial mediterranean fever|Familial Mediterranean fever (periodic peritonitis, familial paroxysmal polyserositis)]]'''
|
* Rare [[Genetic disorder|genetic condition]] which affects individuals of Mediterranean genetic background.
* Etiology is unclear.
* Presents with recurrent bouts of [[abdominal pain]] and [[tenderness]] along with [[pleuritic]] or [[joint pain]]. [[Fever]] and [[leukocytosis]] are common.
|
|
* [[Colchicine]] prevents but does not treat acute attacks.
|-
| colspan="2" |'''[[Granulomatous peritonitis]]'''
|
* A rare condition caused by disposable surgical fabrics or food particles from a [[perforated ulcer]], eliciting a vigorous [[granulomatous]] ([[Hypersensitivity|delayed hypersensitivity]]) response in some patients 2-6 weeks after [[laparotomy]].
* Presents with [[abdominal pain]], [[fever]], [[nausea and vomiting]], [[ileus]], and systemic complaints, mild and diffuse [[abdominal tenderness]].
|
* Diagnosed by the demonstration of diagnostic Maltese cross pattern of starch particles.
|
* The disease is self-limiting.
* Treated with [[corticosteroids]] or [[Anti inflammatory medications|anti-inflammatory agents]].
|-
| colspan="2" |'''[[Sclerosing encapsulating peritonitis]]'''
|
* Seen in conditions associated with long term [[peritoneal dialysis]], shunts like [[Ventriculoperitoneal shunt|VP shunts]], history of [[Abdominal surgery|abdominal surgeries]], [[liver transplantation]].
* Symptoms include [[nausea]], [[abdominal pain]], [[diarrhea]], [[anorexia]], bloody [[ascites]].
|
|
|-
| colspan="2" |'''[[Abscess|Intraperitoneal abscesses]]'''
|
* Most common etiologies being [[Perforation|Gastrointestinal perforations]], postoperative complications, and penetrating injuries.
* Signs and symptoms depend on the location of the [[abscess]] within the [[peritoneal cavity]] and the extent of involvement of the surrounding structures.
* Diagnosis is suspected in any patient with a predisposing condition. In a third of cases it occurs as a sequela of [[Peritonitis|generalized peritonitis]].
* The pathogenic organisms are similar to those responsible for [[peritonitis]], but [[anaerobic]] organisms occupy an important role.
* The [[mortality rate]] of serious [[Abscesses|intra-abdominal abscesses]] is about 30%.
|
* Diagnosed best by [[CT-scans|CT]] scan of the abdomen.
|
* Treatment consists of prompt and complete [[CT]] or [[Ultrasound|US]] guided drainage of the [[abscess]], control of the primary cause, and adjunctive use of effective [[Antibiotics|antibiotics.]] Open drainage is reserved for [[abscesses]] for which percutaneous drainage is inappropriate or unsuccessful.
|-
| colspan="2" |'''[[Peritoneal mesothelioma]]'''
|
* Arises from the [[mesothelium]] lining the [[peritoneal cavity]].
* Its incidence is approximately 300-500 new cases being diagnosed in the United States each year. As with [[pleural mesothelioma]], there is an association with an [[Asbestos|asbestos exposure]].
* Most commonly affects men at the age of 50-69 years. Patients most often present with [[abdominal pain]] and later increased abdominal girth and [[ascites]] along with [[anorexia]], [[weight loss]] and [[abdominal pain]].
* Mean time from diagnosis to death is less than 1 year without treatment.  
|
* [[Computed tomography|CT]] with [[Contrast|intravenous contrast]] typically demonstrates the thickening of the [[peritoneum]]. [[Laparoscopy]] with tissue biopsy or CT guided tissue biopsy with [[immunohistochemical staining]] for [[calretinin]], [[cytokeratin|cytokeratin 5/6]], [[mesothelin]], and [[WT1|Wilms tumor 1 antigen]] remain the [[Gold standard (test)|gold standard]] for diagnosis.
|
* At [[laparotomy]] the goal is cytoreduction with [[excision]]. Debulking surgery and intraperitoneal [[chemotherapy]] improves survival in some cases.
|-
| colspan="2" |'''[[peritoneal carcinomatosis]]'''
|
* Associated with a history of [[ovarian]] or [[Malignancy|GI tract malignancy]].
* Symptoms include [[ascites]], [[abdominal pain]], [[nausea]], [[vomiting]].
|
|
|}
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" | Classification of acute abdomen based on etiology
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Presentation
! colspan="3" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Symptoms
! colspan="3" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Signs
! colspan="2" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Diagnosis
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" | Comments
|-
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal Pain
! align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Guarding
! align="center" style="background:#4479BA; color: #FFFFFF;" |Rebound Tenderness
! align="center" style="background:#4479BA; color: #FFFFFF;" |Bowel sounds
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" | Lab Findings
! align="center" style="background:#4479BA; color: #FFFFFF;" |Imaging
|-
! colspan="1" rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Common causes of Peritonitis
! colspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Primary Peritonitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Spontaneous bacterial peritonitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ascitic fluid [[PMN]]>250 cells/mm<small>³</small>
 
* Culture: Positive for single organism
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound for evaluation of liver cirrhosis
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|-
! colspan="1" rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Secondary Peritonitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Perforated [[Gastric ulcer|gastric]] and [[duodenal ulcer]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ascitic fluid
** [[LDH]] > serum [[LDH]]
 
** Glucose < 50mg/dl
 
** Total protein > 1g/dl
 
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Air under [[diaphragm]] in upright [[CXR]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Upper GI [[endoscopy]] for diagnosis
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Acute cholangitis
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | [[RUQ]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Abnormal [[LFT]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows [[biliary]] dilatation
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Biliary drainage ([[Endoscopic retrograde cholangiopancreatography|ERCP]]) + IV antibiotics
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute cholecystitis|Acute cholecystitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | [[RUQ]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Hyperbilirubinemia]]
* [[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows gallstone and evidence of inflammation
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Murphy's sign|Murphy’s sign]]
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute pancreatitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | [[Epigastric]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[amylase]] / [[lipase]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Pain radiation to back
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Acute appendicitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | RLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound shows evidence of [[inflammation]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], [[decreased appetite]]
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Diverticulitis|Acute diverticulitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | LLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound shows evidence of inflammation
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | [[Salpingitis|Acute salpingitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | LLQ/ RLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Pelvic ultrasound]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Vaginal discharge]]
|-
! colspan="2" rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Hollow Viscous Obstruction
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Small intestine obstruction
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | +/-
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Abdominal X-ray|Abdominal X ray]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]]
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Volvulus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hypoactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and [[Abdominal x-ray|abdominal X ray]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]] associated with [[constipation]], [[Abdominal distension|abdominal distention]]
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Biliary colic]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |RUQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |+
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[bilirubin]] and [[alkaline phosphatase]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Renal colic]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Flank pain]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Hematuria]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan and ultrasound
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Colicky [[abdominal pain]] associated with [[Nausea and vomiting|nausea & vomiting]]
|-
! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Vascular Disorders
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ischemic causes
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mesenteric ischemia]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Periumbilical
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]] and [[lactic acidosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]], normal physical examination
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ischemic colitis|Acute ischemic colitis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Hyperactive then absent
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Leukocytosis]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Nausea and vomiting|Nausea & vomiting]]
|-
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hemorrhagic causes
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ruptured abdominal aortic aneurysm]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Unstable hemodynamics
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intra-abdominal or [[retroperitoneal hemorrhage]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Diffuse
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Anemia]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of [[trauma]]
|-
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gynaecological Causes
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Ovarian cyst|Ovarian Cyst]] Complications
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |Torsion of the cyst
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]]
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cyst rupture
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>+/-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Increased [[ESR]] and [[CRP]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Sudden onset sever pain with [[nausea and vomiting]]
|-
!style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pregnancy
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |Ruptured [[ectopic pregnancy]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |RLQ / LLQ
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Positive [[pregnancy test]]
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |Ultrasound
|style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of missed period and [[vaginal bleeding]]
|-
|}


==References==
==References==


{{Reflist|2}}
{{Reflist|2}}
[[Category:Needs content]]
[[Category:Arthritis]]
[[Category:Rheumatology]]
[[Category:Gastroenterology]]
[[Category:Immune system disorders]]
[[Category:Genetic disorders]]
[[Category:Inborn errors of metabolism]]
[[Category:Disease]]
{{WH}}
{{WS}}

Revision as of 02:21, 24 August 2017

Familial Mediterranean Fever Microchapters

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FMF must be differentiated from other causes of secondary peritonitis

Differentiating FMF from other causes of peritonitis
Disease Prominent clinical findings Lab tests Tratment
Primary peritonitis Spontaneous bacterial peritonitis
Tuberculous peritonitis
Continuous Ambulatory Peritoneal Dialysis (CAPD peritonitis)
Secondary peritonitis Acute bacterial secondary peritonitis
Biliary peritonitis
Tertiary peritonitis
Familial Mediterranean fever (periodic peritonitis, familial paroxysmal polyserositis)
  • Colchicine prevents but does not treat acute attacks.
Granulomatous peritonitis
  • Diagnosed by the demonstration of diagnostic Maltese cross pattern of starch particles.
Sclerosing encapsulating peritonitis
Intraperitoneal abscesses
  • Diagnosed best by CT scan of the abdomen.
  • Treatment consists of prompt and complete CT or US guided drainage of the abscess, control of the primary cause, and adjunctive use of effective antibiotics. Open drainage is reserved for abscesses for which percutaneous drainage is inappropriate or unsuccessful.
Peritoneal mesothelioma
peritoneal carcinomatosis
Classification of acute abdomen based on etiology Presentation Symptoms Signs Diagnosis Comments
Fever Abdominal Pain Jaundice Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Common causes of Peritonitis Primary Peritonitis Spontaneous bacterial peritonitis + Diffuse - - - Hypoactive
  • Ascitic fluid PMN>250 cells/mm³
  • Culture: Positive for single organism
Ultrasound for evaluation of liver cirrhosis -
Secondary Peritonitis Perforated gastric and duodenal ulcer + Diffuse - + + N
    • Glucose < 50mg/dl
    • Total protein > 1g/dl
Air under diaphragm in upright CXR Upper GI endoscopy for diagnosis
Acute cholangitis + RUQ + - - N Abnormal LFT Ultrasound shows biliary dilatation Biliary drainage (ERCP) + IV antibiotics
Acute cholecystitis + RUQ + - - Hypoactive Ultrasound shows gallstone and evidence of inflammation Murphy’s sign
Acute pancreatitis + Epigastric +/- - - N Increased amylase / lipase Ultrasound shows evidence of inflammation Pain radiation to back
Acute appendicitis + RLQ - + + Hypoactive Leukocytosis Ultrasound shows evidence of inflammation Nausea & vomiting, decreased appetite
Acute diverticulitis + LLQ +/- + - Hypoactive Leukocytosis CT scan and ultrasound shows evidence of inflammation
Acute salpingitis + LLQ/ RLQ - +/- +/- N Leukocytosis Pelvic ultrasound Vaginal discharge
Hollow Viscous Obstruction Small intestine obstruction - Diffuse - + +/- Hyperactive then absent Leukocytosis Abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Volvulus - Diffuse - + - Hypoactive Leukocytosis CT scan and abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Biliary colic - RUQ + - - N Increased bilirubin and alkaline phosphatase Ultrasound Nausea & vomiting
Renal colic - Flank pain - - - N Hematuria CT scan and ultrasound Colicky abdominal pain associated with nausea & vomiting
Vascular Disorders Ischemic causes Mesenteric ischemia +/- Periumbilical - - - Hyperactive Leukocytosis and lactic acidosis CT scan Nausea & vomiting, normal physical examination
Acute ischemic colitis +/- Diffuse - + + Hyperactive then absent Leukocytosis CT scan Nausea & vomiting
Hemorrhagic causes Ruptured abdominal aortic aneurysm - Diffuse - - - N Normal CT scan Unstable hemodynamics
Intra-abdominal or retroperitoneal hemorrhage - Diffuse - - - N Anemia CT scan History of trauma
Gynaecological Causes Ovarian Cyst Complications Torsion of the cyst - RLQ / LLQ - +/- +/- N Increased ESR and CRP Ultrasound Sudden onset sever pain with nausea and vomiting
Cyst rupture - RLQ / LLQ - +/- +/- N Increased ESR and CRP Ultrasound Sudden onset sever pain with nausea and vomiting
Pregnancy Ruptured ectopic pregnancy - RLQ / LLQ - - - N Positive pregnancy test Ultrasound History of missed period and vaginal bleeding

References