A man vomiting bright red blood
A 58 year old man was admitted to the emergency department after a sudden onset of vomiting bright red blood and an episode of black, tarry stools. His medical history included an appendicectomy 20 years ago and alcoholic liver disease. He took no regular drugs, drank 90 units of alcohol a week, and did not smoke.
On examination his body temperature was normal (36.6°C), he was hypotensive (90/56 mm Hg), and he had tachycardia (110 beats/min). He also had palmar erythema, gynaecomastia, and spider naevi on his chest. His abdomen was soft, with no evidence of rebound tenderness or organomegaly. He had tenderness in the epigastric region and his bowel sounds were normal. A digital rectal examination showed black tarry stool.
His haemoglobin concentration was 60 g/L (130-180), and two units of blood were transfused. Once he had been made haemodynamically stable, and after resuscitation with intravenous fluids and administration