Bedside Diagnostic Challenge – A 43-year-old man with abdominal pain and weakness after a liver biopsy

Paul Griner, MD, MACPBedside Diagnostic Challenge, Emergency Medicine, Family Medicine, Internal Medicine, Nurse Practitioner

Bedside Diagnostic Challenge – A 43-year-old man complains of abdominal pain and weakness after a liver biopsy

Test your bedside diagnostic skills with this free clinical case question.

Patient Case

A 43-year-old man underwent a liver biopsy to evaluate a preliminary diagnosis of hemochromatosis.

One and a half hours after the procedure, the patient began to complain of abdominal pain and weakness.

The GI Fellow who performed the liver biopsy examined the patient who was noted to be very pale and apprehensive.

The patient’s vitals at that time were:

  • Temperature: 97.6°F
  • Blood Pressure: 95/75 mm Hg
  • Pulse: 128 beats/minute and regular
  • Respirations: 30 breaths/minute

The abdomen was distended and diffusely tender without rebound tenderness. Bowel sounds were hypoactive. Prior to the liver biopsy, the vital signs were normal.

A blood sample was obtained which showed a hematocrit of 41%.

The GI Fellow contacted the attending and indicated that the findings could not be explained by blood loss and that some other reason for the abdominal swelling and pain should be sought.

Question

Based on the diagnostic value of careful examination …

What did this physician fail to do?

Answer Options:

Obtain a hemoglobin level

Interpret the hematocrit properly

Repeat the hematocrit

Check the urine output

See the Answer:


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About The Bedside Diagnostics Blog Series:

Except for Hospitalists, Emergency Medicine physicians, and Interventional Cardiologists, most physicians will spend the bulk of their professional time with patients in an office setting.

Here is where finely tuned clinical skills are most important in leading to accurate diagnoses, fewer complications resulting from unnecessary tests and procedures, and lower costs. These Bedside Diagnostic Challenges reinforces the value of these clinical skills and tests users on their knowledge of them.

Bedside Diagnostic Challenge questions are issued periodically every month as a free benefit of Med-Challenger.

Subscribe to the Med-Challenger blog for more Diagnostic Challenge blogs and other free clinical content from Med-Challenger.

About the Author:

Paul Griner MD, MACP graduated from the University of Rochester School of Medicine and completed his residency at the Massachusetts General Hospital, Boston, MA. He has served the University of Rochester School of Medicine as Chief Resident in Medicine and as Professor, Department of Medicine. He has served as a Senior Lecturer at Harvard Medical School and consultant at the Massachusetts General Hospital where he introduced a mentoring program for the faculty of General Internal Medicine. Dr. Griner is board certified in internal medicine.