Clinical Case Database / Category: Patient Management
The jaundiced patient with haematemesis
Dr Sarah Brown, Elizabeth Williams FRCP, PhD
Foundation Years Journal, volume 4, issue 5, p.41 (123Doc Education, London, May 2010)
A 69-year-old man with known cirrhosis secondary to alcoholic liver disease presented to the A&E department. Prior to his presentation he reported having vomited several large cupfuls of bright red blood and then proceeded to have a further 500ml of fresh haematemesis while in the department. On examination he was pale, clammy, hypotensive and peripherally shut down, with a pulse of 105/min and blood pressure 90/40. He had peripheral stigmata of chronic liver disease including icteric sclera, multiple spider naevi and palmar erythema. Abdominal examination revealed hepatosplenomegaly and ascites. He was not clinically encephalopathic. Despite previously completing a community alcohol detoxification programme he had not been able to remain abstinent and had consumed approximately 50 units of alcohol in the preceding 3 days.
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Dr Sarah Brown
Department of Gastroenterology
Poole Hospital NHS Foundation Trust
Longfleet Road, Poole, Dorset, BH15 2JB
Elizabeth Williams FRCP, PhD
Poole Hospital NHS Foundation Trust, Poole, UK
5. Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L (2005) Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding (Cochrane review). In The Cochrane Library, Issue, 4. London: John Wiley & Sons.
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About the Clinical Cases Database
The 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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