Bedside Diagnostic Challenge – A 56-year-old, post-menopausal woman with enlarging abdomen
A 56-year-old, post-menopausal woman presents with the complaint of an enlarging abdomen. She states that she noticed her dresses becoming tighter over the past 2 months.
She measured her abdominal girth a few days ago and noted that it was 3 inches larger than her usual size. She has not had abdominal pain, nausea, vomiting or change in bowel habits. She has gained 5 pounds over this period without any change in her dietary habits.
Significant past medical history includes cancer of the ovary treated with bilateral salpingo-oophorectomy and chemotherapy five years ago. Annual checkups have not revealed any evidence of recurrence. She does not smoke. She admits to 2-3 bottles of beer a day. A review of systems does not uncover any other symptoms. Family and social histories are unremarkable.
Physical examination shows a patient of stated age. She does not appear ill. Weight is 56 Kg, blood pressure is 118/70 mmHg, pulse is 68 and regular, and respiration’s are 16/minute. Skin and mucus membrane color is normal. A few spider angiomas are noted over the chest wall and the face.
Examination of the heart and lungs reveal no abnormalities. The abdomen is moderately distended and a firm liver edge is felt 5 cm below the right costal margin. There is no tenderness. The spleen is not palpable. A fluid wave is present and a small amount of white, slightly oily fluid, is oozing from the umbilicus. On slight compression of the abdomen, more fluid is freely expressed. It has no odor.
The neurological examination reveals no abnormalities.
Physical examination reveals an obese patient of stated age who does not appear ill.
When questioned about the fluid, she said that it first appeared about 3-4 day ago.
Based on the diagnostic value of careful examination… What is the most likely organ system responsible for these findings?
The GI tract
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.
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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.