Exposé: Different Faces of a Bleeding Giant Duodenal Ulcer
Stanford Multidisciplinary Seminars
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Case Presentation and Evolution
A 78-year old woman was brought to the Emergency Department by paramedics because of hematemesis, melena, and severe hypotension. She had a background history of mild dementia, chronic alcoholism and compensated alcoholic cirrhosis, chronic iron deficiency anemia, chronic left foot neuropathic ulceration, seizure disorder, and a remote history of breast cancer, cerebrovascular accident, and fall-related pelvic fracture. There was no history of prior cigarette smoking, or peptic ulcer disease. At presentation, she was lethargic, hypotensive (BP = 84/40) and mildly tachycardic and tachypneic. Her hemoglobin was 9.8 mg/dl, but after initial fluid boluses, it dropped to 7.4 despite the transfusion of two units of blood. She reported no abdominal pain. Her heart and lung examination was normal; her abdomen was obese but soft without organomegaly. She did not have any stigmata of cirrhosis or ascites. Electrocardiogram and troponin levels suggested demand...
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