Assalamualaikum
So i had this patient xx, a male who had been admitted to hospital with upper abdominal pain, associated with constipation and distended abdomen about 2-3 weeks prior admission. He had background history of persistent vomiting, loss of appetite and loss of weight.
What would you diagnose?
.....first have to clarify more on history lah.....
upper abdominal pain;
site- centrally located
onset- 2 weeks ago
character- stabbing
radiating- left & right lumbar, also to the back
aggravating factor- unknown
timing- sudden onset, continuos
eliminating factor- unknown
severity score- 10/10
ass. symptom- could not sleep at night
Constipation
onset- 2 weeks ago
character of stool- pellet, solid
presence of blood- no
pain during defecation- ?
medication- ?
Distended abdomen
notice 3 weeks ago
no pain
right upper abdomen
unilateral
Persistent vomiting
onset- December 2010
frequency- 5-6 times per day
colour- yellowish
viscosity- thick
content- food particles
blood- no
aggravating factor- food intake
Loss of appetite & loss of weight
duration- since December 2010
weight loss- 27 kg
Important notes;
Mild hypertension
Mom died of liver cancer
Dad has diabetes & hypertension
Smoking cigarettes about 15 cigarettes/day.
Drank alcohol for fun since 1999 to 2005
On general examination everything was normal except there is some yellowish discoloration on his sclera
On physical examination, there was distention of right upper abdomen. There also generalized tenderness of abdomen except left hypochondriac region. There was palpable mass located on right hypochondriac region. There is generalized abdominal guarding. On percussion and palpation, hepatomegaly could be noted.
at the end of day, i was wondering what this guy actually have! Liver problem ke?
the doctors in ward used to give another diagnosis, X. However X is less likely to cause the severed pain like that lah.
But what shocked me the most is blood test showed HEPATITIS B POSITIVE !
T.T
and what sucked the most is, i was the one that got to do the abdomen PE on him. totally fail, and the doctor used to say ' kena praktis lah ' right on my hand and face.
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