A 45 year old man, known to be chronically addicted to alcohol, presents in the emergency department and reports two episodes of vomiting fresh bright red blood in the previous 6 hours. He estimated the volume blood vomited at each bout to be more than 500mls. Clinical exam: the radial pulse 120/min, BP 90/60mmHg. There is no mass or tenderness in the epigastrium. The liver is palpable for 3 cm below the costal margin and not tender. The patient is not jaundiced. The physician resuscitates the patient with oxygen by face mask, rapid infusion of intravenous normal saline while he requests for haemoglobin level and whole blood for transfusion. Which is next appropriate step in management?
- Barium Swallow
- Exploratory laparotomy
- CT scan of the abdomen
- Upper gastrointestinal endoscopy
The key is D. Uppergastrointestinal endoscopy. [The likely diagnosis is bleeding oesophageal varices which should be diagnosed by endoscopy and if needed stappling can be done with endoscope].
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