Weekend Case Discussion - 31/7/16Created by:
Middle aged gentleman, background of ex-intravenous drug user, chronic hepatitis C, previous perforated duodenal ulcer which was repaired, and alcohol dependancy, was admitted due to episode of collapsed and hypothermia of around 35 celcius. Patient was a very vague historian, with some compliants of intermittent coffe ground vomiting and few episodes of malaena last week. Patient has been drinking around 12-14 unit or alcohol everyday since 3 weeks ago. No other symptoms. Episode of collapse was due to general weakness, with no loss of conscious. Patient's temperature was back to normal in emergency department. PR examination shows FOB positive. Hb was 3.3, and the repeat sample was 3.2, significant drop from 14.1 few months ago !!!! INR was 1.9, with low albumin, but normal platelet level and glucose level, only very minimal deranged liver function, mixed pattern. He did has normal U/S abdominal 4 years ago. What is your working diagnosis and differential diagnosis ?? What is your managment plan?