hey everyone here i'll introduce some intersting cases .....and by these cases i want to think and answer carefully....consider it as a challenge to you medical knowledge.............and i'll give you the answer after several replies....


Case 1: The parents of a 3 year old who you have been following since birth for biliary atresia, call to report a "nosebleed" (epistaxis) overnight. Closer questioning discloses that what they are calling a nosebleed is simply a puddle of blood found on the pillow. Having anticipated this potential complication, you ask them to meet you in the Emergency Department. There you find him to be in no distress, with no tachycardia or diaphoresis. You can find no site of bleeding in the nose or pharynx, and you also note his ascites has disappeared and his spleen seems smaller than when you saw him last week.What's going on?

really interesting....
I'm thinking of upper GI bleeding, coz ascites is usually associated with esophagyal varices that may bleed, but I don't know y other things like the decreased spleenomegaly occured? probably coz he lost some volume and thus the pressure decreased?!

can't wait to know the answer

hi kadem you are right ...here's the right answer

. In children with varices and ascites (both arising from portal hypertension) the acute volume loss from the bleeding can be repleted by 'auto-infusion' of the ascites. Portal hypertension triggers ascites at relatively low pressures (10-12 mm Hg), and the volume depletion from bleeding results in enough reduction in the portal pressure to coax the fluid back into the circulation. The hypovolemic state accounts for the loss of the previously existing splenomegaly. These patients also illustrate that all blood loss is whole blood and that the hemoglobin and hematocrit will not fall until they are volume repleted with crystalloid or plasma

here's another one

Case 2


from the history given by this patient give a proper Dx

I am careful not to wake the children as I make my way down the stairs .if they were to witness my nightly ritual, they'd never see me the same way again. their father, fearless protector, diligent provider ,crawling about in tears, beating his head on the hard wood floor ,the pain is so intense that I want to scream, but I don't do so. I squeeze my head , and bind my head firmly between my arms ….but no relief .I squeeze my eye as hard as I can, I try to reach the telephone for a diversion but no use…as the demon keeps on cursing me with each blow on my temple.

What does he have???(Concentrate on every sentence he said)

isn't it a case of cluster headache?