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Abstract: A 20-year-old female presented with abdominal pain and fever with nausea and vomiting 10 days ago with no apparent cause. After admission, the diagnosis was clear and he was treated with medication. After active treatment, the patient’s fever, abdominal pain, nausea and vomiting have been significantly reduced, and she has resumed normal life and work.
Basic information】Female, 20 years old
Disease Type】Tuberculous peritonitis
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of Consultation】March 2022
Treatment plan】Medication (prednisone acetate tablets + ethambutol hydrochloride tablets + pyrazinamide tablets + isoniazid tablets + rifampicin capsules)
[Treatment period] Hospitalization for 11 days, review as prescribed by the doctor
Treatment effect】Fever, abdominal pain, nausea and vomiting disappeared, and normal life and work resumed
I. Initial consultation
The 20-year-old patient had just entered society and started working. Some time ago, she suddenly developed pain around the umbilicus, accompanied by nausea and vomiting, and other uncomfortable symptoms, and at that time, she thought it was because she had accidentally eaten bad food and did not pay special attention to it. After listening to the description of the patient’s condition, I decided to perform an abdominal CT examination to further confirm the disease. The examination soon returned disorganized intestinal tube arrangement in the small intestine in the abdominal cavity, some intestinal tube wall thickening, some intestinal lumen narrowing, some intestinal lumen dilatation, and multiple small shallow air-fluid plane shadows were visible. The mesenteric fat gap was blurred, the omentum was pancake shaped change, and multiple small nodular shadows were seen. The peritoneum was diffusely thickened and multiple small nodular shadows of varying sizes were seen, with the peritoneum predominantly at the lower hepatic margin and the anterior margin of the left lobe of the liver. No significant obstructive dilatation of the colon was seen. Multiple enlarged lymph nodes were seen in the retroperitoneum and mesenteric roots, and fluid density shadow was seen in the abdominal cavity and pelvis with partial encapsulation. Therefore, a diagnosis of tuberculous peritonitis was made. The patient and his family were informed of his condition and were recommended to be hospitalized for drug treatment, and the patient was hospitalized on the day of consultation.
II. Treatment history
The diagnosis of tuberculous peritonitis was clear, and after the patient was admitted to the hospital, a physical examination was performed. The patient was then given short-term treatment with prednisone acetate tablets, combined with ethambutol hydrochloride tablets, pyrazinamide tablets, isoniazid tablets, and rifampin capsules.
III. Treatment effect
After 3 days of treatment, the patient’s fever subsided. After 7 days of treatment, the patient’s abdominal pain, nausea and vomiting were reduced, and prednisone acetate tablets were instructed to reduce the dosage as appropriate. After 11 days of treatment, the patient’s blood routine and biochemistry were normal, and he was in good mental condition. The patient requested to be discharged from the hospital. According to the patient’s symptoms and signs, it was agreed that the patient should be discharged from the hospital to continue drug treatment and to regularly visit the outpatient clinic for review and monitoring of disease development.
IV. Notes
We are glad that after a series of treatment, the patient’s condition has been greatly relieved, but the follow-up treatment needs to be continued.
1, after discharge from the hospital must pay attention to rest, work and rest, diet more high-protein, high-calorie, high vitamin and easy to digest food, avoid eating spicy and stimulating food.
2, can be appropriate sports and exercise to enhance their own physical fitness, to prevent recurrent attacks.
3, after discharge from the hospital according to the doctor’s orders to review the blood routine, biochemistry, to facilitate the doctor to monitor the development of the disease, at the same time to take medication on time, do not stop the medication, after the review according to the doctor’s recommendations to adjust medication.
4. Patients are prone to anxiety, fear and depression due to discomfort, so health care workers need to pay attention to help patients adjust their mindset, divert their attention and actively cooperate with treatment in order to effectively promote disease recovery.
V. Personal insight
In this case, the patient had recurrent abdominal pain, nausea and vomiting with fever, and the final diagnosis of tuberculous peritonitis was confirmed by the combination of ancillary tests. It should be noted that tuberculous peritonitis usually has the following symptoms.
1. systemic symptoms of TB toxemia are more common, mainly fever and night sweats.
2, abdominal pain mainly located in the lower abdomen around the umbilicus or the whole abdomen, manifested as persistent or paroxysmal vague pain, occasionally appearing as acute abdomen.
3, abdominal examination its abdominal examination is more characteristic, generally manifesting as a rubbing sensation.
4, abdominal distension, ascites: there is obvious abdominal distension, and accompanied by abdominal bulging.
5, abdominal masses are mainly seen in the adherent type, mainly around the umbilicus.
Therefore, if patients have the above discomfort symptoms, they should promptly seek medical consultation to clarify the cause and carry out targeted treatment.