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A 40-year-old man with long-standing alcohol abuse complains of abdominal swelling, which has been progressive over several months. He has a history of gastrointestinal bleeding. On physical examination, there are spider angiomas and palmar erythema. Abdominal collateral vessels are seen around the umbilicus. There is shifting dullness, and bulging flanks are noted.

Which of the following is the most important first step in the patient's evaluation?
a. Diagnostic paracentesis
b. Upper GI series
c. Ethanol level
d. CT scan of the abdomen
e. Examination of peripheral blood smear
 

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i think option A is correct since it has both diagnostic and therapeutic role
after restriction of Na and diuretics repeated paracentesis will treat large ascites
and also you can diagnose transudative or exudative nature of fluid & send fluid for culture (possible spontaneous bacterial peritonitis)
CT of abdomen although can diagnose liver carcinoma as a result of cirrhosis but it won't be FIRST diagnostic approach
please write explanations and source of question.
 

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i think option A is correct since it has both diagnostic and therapeutic role
after restriction of Na and diuretics repeated paracentesis will treat large ascites
and also you can diagnose transudative or exudative nature of fluid & send fluid for culture (possible spontaneous bacterial peritonitis)
CT of abdomen although can diagnose liver carcinoma as a result of cirrhosis but it won't be FIRST diagnostic approach
please write explanations and source of question.
Here's my take on this vignette: The patient has cirrhosis (signs/sx) and PE shows (+) ascites. SBP should be sought after for a possible cause of the ascites before anyother imaging studies. So A is still my answer. But who knows. :))
 
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