A 48-Year-Old With Cirrhosis and Sudden Abdominal Distension

Jennifer L. Martindale, MD; Jonathan Elmer, MD; Joshua M. Kosowsky, MD


April 05, 2023

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A 48-year-old man is called into his primary care provider's office to discuss abnormal laboratory values from a specimen drawn during a prior visit. The patient has alcoholism and was recently diagnosed with cirrhosis. Upon presentation, the patient has developed increased abdominal distension and looks generally unwell. He is advised to report immediately to the nearest emergency department (ED).

At the ED, the patient describes vague abdominal pain that is dull in nature and poorly localized. Paracentesis is performed to exclude spontaneous bacterial peritonitis. The ascitic fluid obtained is grossly hemorrhagic, with a spun hematocrit (HCT) of 20%. His serum HCT has dropped dramatically, from 41.5% 2 days earlier to 25.9% in the ED. His international normalized ratio (INR) is 1.7. He is started on intravenous fluids, vitamin K is administered, and he is transferred to another ED for a higher level of care.


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