Kirstin Blackie Nima Mohan. Medical Abdomen. Be aware of common conditions presenting with abdominal symptoms Understand important factors in the history, examination, investigation and management of common abdominal pathologies. Objectives. Causes of Abdo Pain.
Mr C is in monogamous sexual relationship with girlfriend for 2 months– she is on OCP. No barrier contraception.
Drinks approximately 30 units alcohol / week. Denies any other risk factors.
Abnormal clotting (prolonged PT or INR) may indicate acute liver failureLiver Function Tests
Does the presence of ascites prove that this patient has liver disease?
likely increased biliruben, AST, ALT, alk phos, GGT;
Decreased albumin, increased PT/INR (reduced synthetic function);
Decreased WCC and platelets (hypersplenism);
Look for the cause: serology, autoantibodies, iron studies
Imaging: liver US and doppler, MRI
Biopsy: confirm clinical diagnosisHow would you investigate decompensated liver disease?
What other questions would you askher???Case Study
She reports .......
On examination ......
What is your immediate management plan?
6 months of symptoms before diagnosis
Can be predominantly constipation or predominantly diahorrea.
Abdominal pain/ Bloating
Anxiety / depression
Incomplete emptying/ incontinence/ urgency
Constitunal symptoms : tiredness, lethargy, arthalgia, urinary symptoms, dyspurunina.
RED FLAG SYMPTOMS:
Bleeding, Nocturnal symptoms, weight loss, Age > 50Irritable bowel Syndrome
He also reports that he has a back ache for the past fortnight and has been taking OTC painkillers for it and would like you to prescribe some more”Case Study
CALL FOR HELP
Bleeding secondary to variciesBleeding secondary to ulcers
A catheter into the hepatic vein, guidewire was passed into a portal vein branch. The tract was dilated with a balloon, and contrast injected. A metallic stent placed over the wireTIPS