A 45 year old man presents in the Emergency Room with a two day history of...

A 45 year old man presents in the Emergency Room with a two day history of black covered stools and recurrent nosebleeds. His history reveals both a recent as well as past history of ethanol abuse. His coagulations studies reveal:

Platelet Count: 60,000/cumm

PT: 20 sec

APPT: 52 sec

Thrombin Time: 11 sec

Fibrinogen: 201 mg%

FDP greater than 40 ?g.ml

1. What is the probable diagnosis?

2. What additional tests should be performed to confirm the diagnosis?

Solutions

Expert Solution

Black Stools from Nosebleeds: While it's not very common, it is possible that a nosebleed can result in a stool that appears black. A very severe nosebleed that results in a person swallowing a lot of blood could cause black stools. The blood makes it all the way through the digestive system and appears black or dark by the time it is eliminated from the body.

Alcohol (Ethanol) is known to be toxic to liver cells, known as hepatocytes, and it causes inflammation of the liver. The effect of alcohol on hepatocytes is immediate. Repeated high levels of exposure to alcohol causes chronic and continuing inflammation of the liver, which causes the development of scarring to the liver. This scarring is the beginning of alcoholic liver disease. Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases. Cirrhosis occurs in response to damage to your liver.

The symptoms of alcoholic liver disease vary based on the severity of the disease. Commonly reported symptoms include:

* Nausea and vomiting
* Abdominal pain
* Jaundice
* Bloody or dark bowel movements
* Nosebleeds or bleeding gums

Diagnosis:

Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical conditions show a damaged liver.

To test for liver disease, your doctor might recommend:

Liver function tests

Blood tests (A blood test may also look for signs of abnormal blood clotting, which can indicate significant liver damage).

Further testing: Imaging tests

Scans may be needed to produce detailed images of your liver. This may include:

An ultrasound scan

A computerized tomography (CT) scan

A magnetic resonance imaging (MRI) scan

Nightingale answered 1 year ago

Next > < Previous

Related Solutions

A 45-year-old, 6-foot tall man presented to the emergency room with a two day history of...

A 45-year-old, 6-foot tall man presented to the emergency room with a two day history of fever and cough productive of brown sputum. He was hemodynamically stable at the time with a blood pressure of 130/87. His chest x-ray showed a right middle lobe infiltrate and his room air ABG showed: pH 7.32, PCO2 32, PO2 78, HCO3 - 18. He was started on antibiotics and admitted to the floor. Four hours later, the nurse calls because she is concerned...

A 50-year-old man, who is a chronic alcoholic, presents to the emergency room with a sudden...

A 50-year-old man, who is a chronic alcoholic, presents to the emergency room with a sudden onset of abdominal pain that radiates to the back. A blood test reveals elevated serum pancreatic lipase levels and a CT abdomen suggests inflamed pancreas. Both of these findings together confirm the diagnosis of acute pancreatitis. The patient was admitted and appropriately managed. The pain reduces over the next two days. On day 3, the patient reports worsening of pain, nausea, and vomiting. An...

A 36-year-old woman presents to the emergency room with a history of right upper quadrant pain,...

A 36-year-old woman presents to the emergency room with a history of right upper quadrant pain, shaking chills and jaundice. This pain came on suddenly 6 hours earlier and has been progressing. She took her temperature at home and it was 102 F. She vomited once at the onset of pain. She has had intermittent episodes of epigastric and right upper quadrant pain after eating, for the past 6 months. The pain always abated after 30-60 minutes. Her BP is...

Mr. Jenaro is a 61-year-old Spanish-speaking man who presents to the emergency room with his wife...

Mr. Jenaro is a 61-year-old Spanish-speaking man who presents to the emergency room with his wife Dolores. Mrs. Jenaro is also Spanish speaking, but understands some English. Mr. Jenaro complains of nausea and vomiting for two days and symptoms of confusion. His blood glucose is 796 mg/dL. Intravenous regular insulin (Novolin R) is prescribed and he is admitted for further evaluation. He will require teaching regarding his newly diagnosed diabetes. Mr. Jenaro is newly diagnosed with diabetes. His hemoglobin A1C...

J.P. is a 45-year-old man who presents to the outpatient clinic with two swollen toes on...

J.P. is a 45-year-old man who presents to the outpatient clinic with two swollen toes on his right foot. He does not recall injuring his foot. Subjective Data Pain level is a 6/10 location = right foot, throbbing Works as a truck driver Objective Data Vital signs: T 37 P 80 R 14 BP 120/68 +2 edema great toe and second toe, right foot, warm to touch + pulses +2 capillary refill Questions What other assessments should be included for...

Part 2 J.P. is a 45-year-old man who presents to the outpatient clinic with two swollen...

Part 2 J.P. is a 45-year-old man who presents to the outpatient clinic with two swollen toes on his right foot. He does not recall injuring his foot. Subjective Data Pain level is a 6/10 location = right foot, throbbing Works as a truck driver Objective Data Vital signs: T 37 P 80 R 14 BP 120/68 +2 edema great toe and second toe, right foot, warm to touch + pulses +2 capillary refill Questions 1. What other assessments should...

42-year-old man presents to ED with 2-day history of dysuria, low back pain, inability to fully...

42-year-old man presents to ED with 2-day history of dysuria, low back pain, inability to fully empty his bladder, severe perineal pain along with fevers and chills. He says the pain is worse when he stands up and is somewhat relieved when he lies down. Vital signs T 104.0 F, pulse 138, respirations 24. PaO2 96% on room air. Digital rectal exam (DRE) reveals the prostate to be enlarged, extremely tender, swollen, and warm to touch. The factors that affect...

42-year-old man presents to ED with 2-day history of dysuria, low back pain, inability to fully...

42-year-old man presents to ED with 2-day history of dysuria, low back pain, inability to fully empty his bladder, severe perineal pain along with fevers and chills. He says the pain is worse when he stands up and is somewhat relieved when he lies down. Vital signs T 104.0 F, pulse 138, respirations 24. PaO2 96% on room air. the prostate is enlarged, extremely tender, swollen, and warm to touch. What is the diagnosis?

A 2-year-old child presents to the pediatrician’s office with a two-day history of fever, vomiting and...

A 2-year-old child presents to the pediatrician’s office with a two-day history of fever, vomiting and diarrhea. The nurse obtains the child’s temperature, pulse, and respirations. Temp was 101.3 (38.5 C), HR 156, Respirations 32. The child appears tired but alert and clings to mother when the nurse is obtaining vital signs. What other assessments are necessary and the nurse would need to complete next.

Case 1: A 45-year-old man with a history of depression presented to the ED with the...

Case 1: A 45-year-old man with a history of depression presented to the ED with the complaint of feeling suicidal. The patient had cut himself after an argument with his wife. His family called 911; the police and EMS responded and transported him to the ED. The initial suicide screening revealed that the patient did not want to live and intended to kill himself. Because of this initial screening, the ED nurse initiated “high risk behavioral health precautions.” The physician...

Subjects