Tuesday, July 13, 2010

Abdominal Complaint

A pleasant 45 year old male presented to the ER with a complaint of abdominal distension. He had no past medical problems. He was released from jail about 3 months prior after years of being locked up.

He was concerned because his stomach had been getting larger since he got out of jail. He went to an urgent care clinic 3 days before coming to the ER. The "doctor" at the urgent care told him that he was retaining fluid in his abdomen, probably because of liver/kidney/heart failure, and gave him lasix to help get the fluid off. No tests were made to help him get to this diagnosis.

I wasn't that impressed with his exam. No peripheral edema. No heart murmur. No fluid in his lungs. No skin changes concerning for liver failure, and no fluid wave in his abdomen. I told him we would do some tests to get to the bottom of things.

Nurse: "So what do you think is the matter with him."

Me: "I think he has enjoyed to much McDonalds since getting out of jail and has just gotten fat."

Nurse: "You are such as asshole doctor. You always think the worse for these poor patients. That man is probably dying from liver failure and you just think he is fat b/c you wish you could eat more McDonalds and let yourself go. Your such an dickhead....but damn I want you. Please take me now" Just kidding. She didn't say anything, just chuckled and looked at me like I was an idiot.

So....the tests came back. Normal kidney function, normal liver function, no heart failure, no fluid in his belly per ultrasound. Diagnosis= pot belly. He was relieved. I recommended diet, exercise, and stopping the lasix.

-ER Doc


PathologyGrrl said...

We call that "biscuit poisoning".

WhiteCoat said...

Reminds me from a scene from scrubs.

Sarah said...

I say this with the most politeness possible- I absolutely love reading your blog. But, could I request that you stop the heavy profanity? I want to be able to continue reading. It;s so funny, and would be just as much so without it. It used to be only a little but seems to be a lot more lately. Thank you so much for writing.

SerenityNow said...

Re WC:

Ahhh....Scrubs. One of the best shows on hospital life (not cases but day to day life) ever. Although I am more of a Turk than a JD

-ER Doc

GrowUp said...

The only profanity used in that post was asshole and dickhead. Lighten up sarah. Go hang out in the ER and you will hear more F bombs than you would at a comedy club

ERP said...

That "nurse's voice" line friggin' cracked me up.

Sarah said...

@GrowUp. I refer not only to this post but to several others. I don't hang out in the ER for a reason. I said it politely and used manners, something someone with the name "GrowUp" might not comprehend.