Gastroenterology
Case 21: A Patient with Abdominal Distension
CASE
A 62‐year‐old man is admitted with abdominal distension. He admits to having been unwell for the previous 12 months experiencing fatigue, weight loss and difficulty sleeping. He had had previous surgery for peptic ulcer disease 20 years ago but since then had not been a regular attender at his GP practice. He gave up work as a pub landlord 7 years ago.
On examination he appears to have lost proximal muscle mass. He has palmar erythema and 2–3 spider naevi over his chest but no other peripheral signs of chronic liver disease. He is in atrial fibrillation. Abdominal examination demonstrates gross ascites and possible splenomegaly. He has mild pitting oedema of the ankles.
Blood tests showed:
Hb 12.2 g/dL WCC 5.6 × 109/L Platelets 98 × 109/L PT 18 sec Na 125 mmol/L K 3.2 mmol/L Urea 1.4 mmol/L Creatinine 98 µmol/L Albumin 23 g/L Bilirubin 65 µmol/L ALP 140 U/L AST 38 U/L
QUESTION 1
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The clinical detection of organomegaly in the presence of ascites might be helped by: