Clinical Case Database / Category: Clinical Care

Acute abdominal bleeding

Publication details

Charis Costopoulos MA MBBchir, Rakesh Patel MB ChB MRCP(UK)
Foundation Years Journal, volume 1, issue 3, p.94 (123Doc Education, London, June 2007)

Abstract

A 72-year-old male was referred to the surgical admissions unit for assessment of a 2-day history of right upper quadrant pain. He also complained of worsening ankle and abdominal swelling. Past medical history was unremarkable and he drank a minor amount of alcohol. On examination, he was tender in the right upper quadrant with a positive Murphy’s sign. Palmar erythema and numerous spider naevi were also noted as well as bipedal oedema and shifting dullness, consistent with the presence of ascites. Examination of the respiratory and cardiovascular system was unremarkable. Ultrasonography confimed the presence of ascites with biliary tree appearances in keeping with acute cholecystitis. The patient was treated conservatively with antibiotics and analgesics. However, his in-patient stay was complicated by massive haemetemesis.

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Authors

Charis Costopoulos MA MBBchir

Academic Medicine FY2 in Cardiovascular Medicine
Division of Cardiovascular Medicine
Addenbrooke’s Hospital, Cambridge

Rakesh Patel MB ChB MRCP(UK) (Corresponding author)

Specialist Registrar in Nephrology
John Walls Renal Unit
Leicester General Hospital
University Hospitals of Leicester NHS Trust
Leicester General Hospital, Leicester, LE5 4PW

References

1.  Rockall TA, Logan RF, Devlin HB, Northfild TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996; 38:316-321

2.  Baradarian R, Ramdhaney S, Chapalamadugu R: Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. Am J Gastroenterol 2004; 99:619-622

3.  Moore KP, Aithal GP. Guidelines on the management of ascites in cirrhosis. Gut. 2006; 55 Suppl 6:vi1-vi12

4.  Lau JY, Sung JJ, Lee KK, Yung MY, Wong SK, Wu JC, Chan FK, Ng EK, You JH,Lee CW, Chan AC, Chung SC. Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med. 2000; 343:310-6

5.  Barkun AN, Herba K, Adam V: High-dose intravenous proton pump inhibition following endoscopic therapy in the acute management of patients with bleeding peptic ulcers in the USA and Canada: a cost-effectiveness analysis. Aliment Pharmacol Ther 2004; 19: 591-600

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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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