Total Confusion

Gastrointestinal System

Step 1: View Clinicals

{"ops":[{"insert":"A 55-year-old man presents with sudden onset hematemesis. He has vomited bright red blood 6 times during the past 3 hours, with about half a cup in volume (~125 mL) each time. He has also become increasingly confused since the onset of symptoms.\n\nThere are no previous episodes of hematemesis, abdominal pain, anorexia or recent weight loss, but he has passed black, tarry stools for a week now.\n\nHe was diagnosed with Hepatitis C ten years ago, which was believed to be secondary to a blood transfusion following an automobile accident. He defaulted on follow-up soon afterwards, and is currently not on any medications.\n\nHe stopped drinking around the same time, and even before this, only drank socially. The remainder of his history is unremarkable.\n\nOn arrival, he is tachycardic at 110 bpm with a blood pressure of 90\/50 mmHg, requiring immediate fluid resuscitation. Subsequently, a nasogastric tube is inserted.\n\nA blood glucose level and serum electrolyte assay are found to be within normal ranges.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-M-228_en.png"}},{"insert":"\n"}]}

Step 2: Order Relevant Investigations

1. Complete blood count
2. Liver profile
3. Ultrasound abdomen
4. Upper gastrointestinal (UGI) endoscopy

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