A 58 y/o male presents to a local hospital with a 3-month history of yellow discoloration of eyes. The patient denies alcohol use, recreational drugs, and has smoked one pack per day for the last 30 years. Most of the preliminary workup is negative for viral hepatitis. A decision is made to perform a liver biopsy. The patient has an uneventful recovery after biopsy and is discharged the same day. He returns 24 hours later with severe abdominal pain and shortness of breath. Vitals show blood pressure, 110/50 mmHg, heart rate 130 bpm, and pulse oximetry shows 85% saturation. Ultrasound of the abdomen is normal. What should be the next step?
|A.||Complete blood count|
CT scan of the abdomen
Ans. c. Chest x-ray
A complete blood count will be helpful if suspecting bleeding. There is no suspicion of bleeding in this case.
CT scan is indicated if bleeding is suspected. In this case, there is no evidence of bleeding
Given the low oxygen saturation, pneumothorax should be suspected as a procedural complication. Though the patient may have chronic obstructive pulmonary disease given the long history of smoking, symptoms of dyspnea combined with low saturation requires further evaluation.
There is no need to repeat ultrasound if the first one is normal