General

CaseDiscussion_ABD pain

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1 Nov 2016 - General
 

A middle aged gentleman with background history of alcohol liver cirrhosis (with oesophageal varices, and ascites), hypertension, smoker of 30 pack years, on-going intermittent alcohol comsumption, was admiited to hospital due to increased in abdominal distension and generalised abdominal pain. He was not drinking any alcohol for the last 2 weeks, but did drank heavily for 1 week prior to that. Patient was no encephalopathy on admission. On examination, patient's abdomen was grossly distended with positive shiftinh dullness, some generalised slight tenderness on palpation. Patient's vitals (blood pressure, respiratory rate, oxygen saturation, temperature, pulse rate) were normal. PFA was normal. There were slight increased in white cell count, neutrophil and CRP, with stable liver function test. What is your differential diagnosis for his abdominal pain ? what is the next appropriate diagnostic test and management plan ?? 

According to the clinical guidelines relating to this case, a paracentesis should be performed in all patients with cirrhosis and ascites to rule out SBP. The same procedure should also be performed in patients with gastrointestinal bleeding, shock, fever, or other signs of systemic inflammation, gastrointestinal symptoms, as well as in patients with worsening liver and/or renal function, and hepatic encephalopathy. The diagnosis of SBP is based on neutrophil count in ascitic fluid of >250/m...
 (Total 90 words)
The patient has a history of alcohol liver cirrhosis, complicated with oesophageal varices and ascites (due to portal hypertension). Given the presentation of abdominal distension and pain, X-ray of abdomen (PFA) will be first required to rule out any possibility of bowel obstruction. In addition, he should have an erected chest x -ray to rule out any perforation. The slight increase in white cell count , neutrophil, and CRP may be suggestive of this patient was having some sort of infection. G...
 (Total 122 words)