PeritonitisDownloads

A 40-year-old man presents with acute abdominal pain. Past medical history is significant for hepatitis C, complicated by multiple recent visits with associated ascites. His temperature is 38.3°C (100.9°F), heart rate is 115/min, blood pressure is 88/48 mm Hg, and respiratory rate is 16/min. On physical examination, the patient is alert and in moderate discomfort. Cardiopulmonary examination is unremarkable. Abdominal examination reveals distant bowel sounds on auscultation. There is also mild diffuse abdominal tenderness to palpation with guarding present. The remainder of the physical examination is unremarkable. A paracentesis is performed. Laboratory results are significant for the following: Leukocyte count 11,630/µL (with 94% neutrophils) Platelets 24,000/µL Hematocrit 29% Ascitic fluid analysis: Cell count 658 PMNs/µL Total protein 1.2 g/dL Glucose 24 mg/dL Gram stain Gram-negative rods Culture Culture yields growth of E. coli Which of the following is the next, best step in the management of this patient?

A 49-year-old woman with a history of hepatitis C cirrhosis complicated by esophageal varices, ascites, and hepatic encephalopathy presents with 1 week of increasing abdominal discomfort. Currently, she takes lactulose, rifaximin, furosemide, and spironolactone. On physical examination, she has mild asterixis, generalized jaundice, and a distended abdomen with positive fluid wave. Diagnostic paracentesis yields a WBC count of 1196/uL with 85% neutrophils. Which of the following is the most appropriate treatment?