Quick Question: 41 YO Man With GI Bleeding

Quick Question: 41 YO Man With GI Bleeding
Jan 31, 2019 1:56pm

February 1, 2019 Quick Question Case

A 41-year-old man was admitted with severe gastrointestinal bleeding. He reported that he drinks an average of 15 ounces of whiskey per day, a habit of 15 years. Upon admission he was given Librium for withdrawal and parenteral nutrition with multivitamins. He was jaundiced and reported the jaundice had appeared 3 weeks before admission. His stools were black. Liver and spleen were enlarged and there was marked ascites and ankle edema. There were numerous ecchymoses over the arms and legs.

Initial Findings

  • HGB : 7.8 g/dL , Reference interval 13.5–18.0 g/dL
  • HCT : 23%, RI 40–54 %
  • PT : 19 s, RI 10.7–13.9 s
  • PTT : 52 s, RI 26.6–40.3 s
  • PLT count: 51,000/uL RI 130,000-400,000/uL
  • D-dimer: 850 ng/mL FEUs, RI 110–240 ng/mL FEUs
  • BP: 110/50

Follow-up

From the history and initial laboratory results, what is the most likely possibility? Please suggest follow-up laboratory testing to confirm a diagnosis.
Refer to the poll on the right to select your answer. To add intormation, please use the Comments section below or email george at george@fritsmafactor.com.

1 Comment

February 1, 2019 Quick Question Case

A 41-year-old man was admitted with severe gastrointestinal bleeding. He reported that he drinks an average of 15 ounces of whiskey per day, a habit of 15 years. Upon admission he was given Librium for withdrawal and parenteral nutrition with multivitamins. He was jaundiced and reported the jaundice had appeared 3 weeks before admission. His stools were black. Liver and spleen were enlarged and there was marked ascites and ankle edema. There were numerous ecchymoses over the arms and legs.

Initial Findings

  • HGB : 7.8 g/dL , Reference interval 13.5–18.0 g/dL
  • HCT : 23%, RI 40–54 %
  • PT : 19 s, RI 10.7–13.9 s
  • PTT : 52 s, RI 26.6–40.3 s
  • PLT count: 51,000/uL RI 130,000-400,000/uL
  • D-dimer: 850 ng/mL FEUs, RI 110–240 ng/mL FEUs
  • BP: 110/50

Follow-up

From the history and initial laboratory results, what is the most likely possibility? Please suggest follow-up laboratory testing to confirm a diagnosis.
Refer to the poll on the right to select your answer. To add intormation, please use the Comments section below or email george at george@fritsmafactor.com.

By George Fritsma
Feb 3, 2019 5:36pm
Tanja Antunovic suggests liver cirrhosis.

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