After completing this case study, the reader should be able to:
List nonpharmacologic options for managing patients with bleeding esophageal varices.
Recommend appropriate pharmacologic therapy for controlling bleeding esophageal varices and adjunctive therapy in the setting of acute variceal bleeding.
Provide appropriate education for patients receiving therapy for portal hypertension.
“I’ve been throwing up blood, enough to fill my bathroom sink!”
Ethyl Johnson is a 55-year-old woman who presents to the ED with complaint of vomiting blood and bright red blood per rectum. She was in her usual state of health, until shortly after taking a dose of lactulose when she began to feel sick and subsequently vomited a large amount of blood into the bathroom sink. She also reports a 2-day history of BRBPR.
Father with CAD and CABG; no other history known.
She lives alone and has been able to function independently. Quit smoking 10 years ago and does not drink alcohol. She works as an accountant.
Negative except for complaints noted in HPI.
Obese female looking older than stated age, looks somnolent but occasionally moves head
BP 108/60, P 120, RR 14, T 37.8°C
Some spider angiomas on abdomen, thick skin, chronic venous stasis changes with lichenification
Clear to auscultation bilaterally
Tachycardia, RRR, no M/R/G
Obese, mildly distended, distant bowel sounds present, difficult to assess for hepatosplenomegaly
Sleepy, moves head occasionally; is arousable and oriented × 3; no asterixis