Skill Checkup: A Man With Itching and Abdominal Pain 

Alastair O'Brien, MBBS, BSc, PhD


March 18, 2021

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 39-year-old man who lives in a major metropolis in the United Kingdom presents to the clinic seeking treatment for intravenous heroin addiction. He has been struggling with drug addiction since his teenage years and has tried to quit several times. He visited the clinic once in the previous year when blood was drawn for testing but he did not follow-up on the results. Today he is complaining of itching all over his body and slight pain in the right upper quadrant of the abdomen. He also reports feeling tired for the past few days but denies having any other symptoms. He states that he is no longer using illicit drugs but drinks alcohol occasionally. He does not have a past medical history of other illnesses, surgeries, or blood transfusions. He is not currently sexually active and does not smoke. He does not have a permanent home address and stays with various friends and relatives. On examination, his vital signs and body mass index are within normal range. There is no obvious yellowing of his skin or sclerae. Track marks are visible on his forearms. Extensive tattoos which he acquired 15 years ago cover his arms and upper torso. Examination of the abdomen reveals slight tenderness on the right upper quadrant, the liver is not palpable, there is no fluid shift, or signs of peritonitis. Examination of other systems is unremarkable.


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