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A 52-year-old alcoholic male comes with the complaints of abdominal distention and respiratory distress. He also complains of weight loss over the past 2 months. On examination, he has diffuse rales in the chest, 2+ pedal edema, and shifting dullness in abdomen. His vitals are: PR: 90/min, Temperature: 37.2C(99F), RR: 18/min. What should be the next best step in the management of this patient?

A. Ultrasonogram.
B. Paracentesis.
C. Chest-X ray.
D. CT abdomen.
E. Liver function tests.
 

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A 52-year-old alcoholic male comes with the complaints of abdominal distention and respiratory distress. He also complains of weight loss over the past 2 months. On examination, he has diffuse rales in the chest, 2+ pedal edema, and shifting dullness in abdomen. His vitals are: PR: 90/min, Temperature: 37.2C(99F), RR: 18/min. What should be the next best step in the management of this patient?

A. Ultrasonogram.
B. Paracentesis.
C. Chest-X ray.
D. CT abdomen.
E. Liver function tests.
: CT abdomen!!
 

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This pt clearly has ascites (shifting dullness & abdominal distention). HCC is also a possibility, given his past history. Why not start with a US as a screening evaluation both for ascites & any potential liver abnormalities, then proceed to paracentesis of the ascitic fluid (to rule out SBB) and then perform further imaging??? Just a thought...
 

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paracentesis !!!

i go with ath.panthelis...the first investigation should be paracentesis ...it'll relieve sm of the respi distress and would be diagnostic as well...no need to straight away send the pt to CT...liver malignancy as such i dont thnk is a contraindication to paracentesis...what say guys ?
 

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i go with ath.panthelis...the first investigation should be paracentesis ...it'll relieve sm of the respi distress and would be diagnostic as well...no need to straight away send the pt to CT...liver malignancy as such i dont thnk is a contraindication to paracentesis...what say guys ?
I will go with Choice B as they pt is in respiratory distress , so relieve distress and then do watwver investigation u like to
 
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