CASE84:VOMITING
History
A 32-year-old man presents to the emergency department at 2 am rather inebriated. He had
been to an end of examinations party that evening, followed by a Chinese meal. He began
to feel unwell around 11.45 pm and vomited twice, brought up his meal and several pints
of lager and initially felt better. Over the next hour or so he retched violently on several
occasions and around 1 am vomited up bright red blood. He says that he noticed just a
small amount of blood on the first occasion but considerably more the second time.
There is no relevant previous medical history or family history. He smokes 10 cigarettes a
day, takes occasional marijuana and drinks 2–3 units of alcohol a week.
Examination
He seems a little drunk. There is some dried blood around his mouth. The pulse is 102/min
and the blood pressure 134/80 mmHg lying, with no change on standing and no other
abnormalities in the cardiovascular or respiratory system. In the abdomen there is a little
tenderness in the epigastrium.
NormalHaemoglobin 13.7 g/dL 13.3–17.7 g/dL
Mean corpuscular volume (MCV) 86 fL 80–99 fL
White cell count 8.6% 109 /L 3.9–10.6% 109 /L
Platelets 315 % 109 /L 150–440% 109 /L
Sodium 138 mmol/L 135–145 mmol/L
Potassium 3.9 mmol/L 3.5–5.0 mmol/L
Chloride 99 mmol/L 95–105 mmol/L
Urea 5.8 mmol/L 2.5–6.7 mmol/L
Creatinine 70 &mol/L 70–120&mol/L
Alkaline phosphatase 184 IU/L 30–300 IU/L
Alanine aminotransferase 27 IU/L 5–35 IU/L
Gamma-glutamyl transpeptidase 39 IU/L 11–51 IU/LINVESTIGATIONS
Questions
- What is the likely diagnosis?
- What is the appropriate management?