|
Case
1 - History
Hypotheses
Intervention
|
A 55 year old
accountant with acute abdominal pain
|
History
A patient is brought to the emergency room with acute abdominal pain. His
ID indicates he is a 55 year old accountant. He appears un-kept with poor body hygiene that
masks any other odour. His abdomen is soft but diffusely tender, distended with ascites;
there are no signs of a localized pain or guarding.
|
Laboratory
findings
-
high blood alcohol concentration (BAC; 250 mg/dcl), with no
other symptoms of intoxication.
-
Patient is febrile, with WBC 17,000; platelets 50k (normal
>150k).
Other findings out of normal
range:
- INR (International Normalized Ratio, a measure of the
state of coagulation) is 3 (normal 1 or below);
- prothrombin
time (PT) is 25 (normal < 13).
- Hepatic enzymes are elevated
(AST > ALT) without cholestatic picture.
|
|
The patient
show signs of acute abdominal problems (peritonism), a likely
result of an infectious process, as indicated by his laboratory
findings.
Spontaneous bacterial peritonitis (SBP),
a common complication of ascites, should be considered.
This
requires pharmacological treatment.
|
|