Clinical Case Database / Category: Clinical Care

Acute abdominal bleeding

Publication details

Charis Costopoulos MA MBBchir, Rakesh Patel MB ChB MRCP(UK)
Foundation Years Journal, volume 1, issue 3, p.94 (123Doc Education, London, June 2007)


A 72-year-old male was referred to the surgical admissions unit for assessment of a 2-day history of right upper quadrant pain. He also complained of worsening ankle and abdominal swelling. Past medical history was unremarkable and he drank a minor amount of alcohol. On examination, he was tender in the right upper quadrant with a positive Murphy’s sign. Palmar erythema and numerous spider naevi were also noted as well as bipedal oedema and shifting dullness, consistent with the presence of ascites. Examination of the respiratory and cardiovascular system was unremarkable. Ultrasonography confimed the presence of ascites with biliary tree appearances in keeping with acute cholecystitis. The patient was treated conservatively with antibiotics and analgesics. However, his in-patient stay was complicated by massive haemetemesis.

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Charis Costopoulos MA MBBchir

Academic Medicine FY2 in Cardiovascular Medicine
Division of Cardiovascular Medicine
Addenbrooke’s Hospital, Cambridge

Rakesh Patel MB ChB MRCP(UK) (Corresponding author)

Specialist Registrar in Nephrology
John Walls Renal Unit
Leicester General Hospital
University Hospitals of Leicester NHS Trust
Leicester General Hospital, Leicester, LE5 4PW


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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