A True Gastrointestinal Emergency

​BY GREGORY TAYLOR, DO, & SHERIF EL-ALAYLI, DOA 60-year-old man with a significant history of alcohol abuse, metastatic hepatocellular carcinoma, and cirrhosis presented to the emergency department complaining of vomiting up bright red blood. The patient was reportedly supposed to have an esophagogastroduodenoscopy (EGD) six months earlier but failed to follow up.He had two episodes of melena the night before and two episodes of hematemesis that morning. He was also experiencing fatigue, weakness, and abdominal pain, which he described as achy and localized to the epigastric region. He had refused treatment for his hepatocellular carcinoma and continued to drink at least 12 beers a day.He was afebrile and had a blood pressure of 97/58 mm Hg, a heart rate of 114 bpm, a respiratory rate of 22 bpm, a weight of 123 kg, and a pulse ox of 99% on room air. The patient appeared ill, and he was sitting up dry heaving with dried blood on his chin. His eyes revealed scleral icterus bilaterally, and he had sinus tachycardia without a murmur and clear lungs. His abdomen was soft but distended, positive fluid wave, and tenderness to palpation within the epigastric region without any peritoneal signs to suggest a bacterial peritonitis.His rectal exam was notable for black stool, hemoccult-positive. His lab results revealed a leukocytosis of 11.2 k/μL, hemoglobin of 9.2 g/dL (baseline of 12), hematocrit 28.9%, and a thrombocytopenia of 142 bil/L (150-450 bil/L), INR of 1.7. A metaboli...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research