What are the most important diagnostic tests to get started (several may be appropriate)?
CT scan of the abdomen and pelvis with contrast
This imaging study could be helpful if we are truly stumped, but there are faster, lower risk tests that are a better choice. In addition, this CT would require contrast, and our patient has residual kidney function that is important to spare. Try again!
Correct, we should always rule out pregnancy in any woman of reproductive age. This patient’s pregnancy test is negative.
Peritoneal fluid sample
Absolutely, any PD patient presenting with abdominal pain should have testing performed on their PD fluid. You remove the fluid (don’t forget to replace it, no PD patient with possible intra-abdominal infection should be left with a “dry” abdomen) and think about what studies you would like to send. The patient also brought in her PD fluid from earlier today, seen here:
Abdominal pain may raise suspicion for a urinary tract infection in this patient. Take a look at her urinalysis results below:
We should always send basic labs, but there are a few other tests that might come back faster and prove higher yield at this time. Take a look at the results below, but then try again!
While there is much that can be diagnosed on kidney ultrasound, this patient’s history and physical exam do not make this the highest yield test at this time. Try again!
What’s moved to the top of your differential diagnosis? Choose 3 before moving on!
Peritoneal catheter exit site infection
Pelvic inflammatory disease
Urinary tract infection
Acute coronary syndrome
Small bowel obstruction
Encapsulating peritoneal sclerosis
Click here to move on!