CASE FOR ABDOMINAL ENLARGEMENT

A 52/male, farmer, from Leyte, chronic alcoholic drinker, was rushed to the hospital because of
change in sensorium. According to his son, 10 days ago, he was noted to have gradual
abdominal enlargement and bipedal edema, but no consult done. 2 days ago he complained of
experiencing black tarry stool twice but no abdominal pain, how-ver, he refused to eat and
didn’t want to be hospitalized. Until, this morning, when he was noted to be sleeping most of
the time with noted fine uncontrollable movements of his extremities. At the ER, he was
stuporous, cachexic, dehydrated looking, vital signs were 90/60 BP, HR 108, RR 24, afebrile.
With pale palpebra, icteric sclera, spider angiomas over the chest, clear breath sounds &
tachycardic. Abdominal exam, noted to have non palpable liver, obliterated traubbes’ space &
positive for fluid wave. DRE showed melena. Extremities showed multiple hematoma
formations.

1. What is your initial impression? Give your basis.

2. What are your differential diagnosis and basis of each?
3. What work ups will you request? (laboratories, imaging studies, endoscopy, others)
Give the rationale why you request such and what are your expected findings.
4. After the diagnostic work ups, what is now the Final diagnosis?
5. How will you manage the case? (pharmacologic, non pharmacologic modalities)
Make a step by step approach on how to deal with the case starting from
management at the ER up to stay of the patient already at the ICU/ward.

PREFERRED REFERENCES:
SLEISENGER AND FORDTRAN’S GASTROINTESTINAL AND LIVER DISEASE, 9th EDITION
HARRISON’S PRINCIPLES OF INTERNAL MEDICINE, 18th EDITION