Alcoholism and Sudden Abdominal Distention in a 48-Year-Old
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Editorial Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 48-year-old man is called into his primary care provider’s office to discuss abnormal laboratory values from a specimen drawn during a prior visit. The patient has alcoholism and was recently diagnosed with cirrhosis. Upon presentation, the patient has developed increased abdominal distension and looks generally unwell. He is advised to report immediately to the nearest emergency department (ED).
At the ED, the patient describes vague abdominal pain that is dull in nature and poorly localized. Paracentesis is performed to exclude spontaneous bacterial peritonitis. The ascitic fluid obtained is grossly hemorrhagic, with a spun hematocrit (HCT) of 20%. His serum HCT has dropped dramatically, from 41.5% 2 days earlier to 25.9% in the ED. His international normalized ratio (INR) is 1.7. He is started on intravenous fluids, vitamin K is administered, and he is transferred to another ED for a higher level of care.
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Cite this: Alcoholism and Sudden Abdominal Distention in a 48-Year-Old – Medscape – Jul 06, 2020.
Jennifer L. Martindale, MD, Resident, Department of Emergency Medicine, Brigham and Women’s Children’s Hospital, Boston, MA
Disclosure: Jennifer L. Martindale, MD, has disclosed no relevant financial relationships.
Jonathan Elmer, MD, Resident, Department of Emergency Medicine, Brigham and Women’s Children’s Hospital, Boston, MA
Disclosure: Jonathan Elmer, MD, has disclosed no relevant financial relationships.
Joshua M. Kosowsky, MD, Assistant Professor & Clinical Director, Department of Emergency Medicine, Harvard School of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Disclosure: Joshua M. Kosowsky, MD, has disclosed no relevant financial relationships.
Craig A. Goolsby, MD, Director, eMedicine Case of the Week; Staff Physician, Department of Emergency Medicine, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, TX
Disclosure: Craig A. Goolsby, MD, has disclosed no relevant financial relationships.
Usama Basit, MD, MBBS, Reviewer, eMedicine Interactive Case Studies (CME Case of the Week), Rawalpindi, Pakistan
Disclosure: Usama Basit, MD, MBBS, has disclosed no relevant financial relationships.
Tomasz Guzowski, MD, FRCPC, Internal Medicine and Gastroenterology, Stanton Territorial Hospital, Yellowknife, Canada; Assistant Professor of Medicine, University of Alberta
Disclosure: Tomasz Guzowski, MD, FRCPC, has disclosed no relevant financial relationships.
S.A. Jamal Bokhari, MD, Associate Professor of Radiology – Yale University School Of Medicine. Section Chief Emergency Radiology, Assistant Program Director Radiology Residency – Yale New Haven Hospital, New Haven, CT
Disclosure: S.A. Jamal Bokhari, MD, has disclosed no relevant financial relationships.
Luis M. Soler, BA, Associate Editor, eMedicine/Medscape, New York, NY
Disclosure: Luis M. Soler, BA, has disclosed no relevant financial relationships.
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Alcoholism and Sudden Abdominal Distention in a 48-Year-Old
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