Unusual cause of bleeding in liver cirrhosis patient

摘要

A 42-year-old man presented to the emergency department with 2 weeks history of fatigue and dark tarry stool. He had past medical history significant for primary sclerosing cholangitis with liver cirrhosis, complicated with ascites and small non-bleeding esophageal varices. He denied nausea, vomiting, abdominal pain, weight loss or change in appetite. He also denied excessive use of non-steroid anti-inflammatory drugs (NSAID's). On presentation he was on spironolactone, furosomide, omeprazole and nadalol. On exam, he appeared pale with stable vitals signs. Skin examination revealed spider angiomata and palmar erythema. Abdomen was non-distended with no abdominal tenderness or organomegaly. There was no asterixis.