A 49-year-old woman presents to the emergency department complaining of a 4-week history of progressive abdominal swelling and discomfort. She has no other gastrointestinal symptoms, and has a normal appetite and normal bowel habits. Her medical history is significant only for three pregnancies, one of which was complicated by excessive blood loss, requiring a blood transfusion. She does not smoke and drinks only occasionally. On pointed questioning, she admits that she had multiple sexual partners in her young days and snorted cocaine once or twice at parties many years ago. She does not use drugs now. She was HIV negative at the time of the birth of her last child.

On examination, her temperature is 37.9oC, heart rate is 88 bpm (normal heart rate is 60- 100 bpm) and blood pressure is 94/60 mm Hg. She is thin, her complexion is sallow, her sclerae are icteric, her chest is clear and her heart rhythm is regular with no murmur.

Her abdomen is distended, with mild diffuse tenderness, hypoactive bowel sounds, shifting dullness to percussion, and a fluid wave. She has no peripheral edema. Laboratory studies are normal except for Na 129 mEq/L (normal 135-145), albumin 2.8 g/dL (normal 3.5- 5g/dL), total bilirubin 4 mg/dL, prothrombin time 15 seconds (normal 11-13.5), hemoglobin 12g/dL with mean cell volume (MCV) 102 fL (normal 78-95), and platelet count 78,000 /mm3 (normal 150,000 – 500,000).

a. What is the most likely diagnosis? List out all your considerations to arrive at the decision. Elaborate the pathogenesis of her progressive swelling abdomen. (18 marks)

b. What are the essential considerations for prompt treatment? (2 marks)

Answer rating: 100% (QA)

a The most likely diagnosis for this patient is cirrhosis with ascites Considerations leading to this diagnosis include Risk factors The patient has a history of excessive blood loss during one of her ... View the full answer