Gastro Case Challenge: After Routine Procedure, 52-Year-Old Has Black Vomit, Diarrhea

Sarah El-Nakeep, MD

Disclosures

February 27, 2023

Physical Examination and Workup

The patient's temperature is 102.2 °F (39 °C); her pulse is 110 beats/min; her blood pressure is 90/60 mm Hg; and her respiration rate is 28 breaths/min. The abdominal examination shows tenderness and guarding all over the abdomen but no rigidity. The general examination reveals no jaundice, lower limb edema, or inflammation. The patient is fully conscious.

Laboratory investigations reveal these values:

  • White blood cell count: 20,000 cells/µL (reference range, 4500-11,000 cells/µL)

  • Hemoglobin level: 8 g/dL (reference range, 11.6-15 g/dL)

  • Platelet count: 300,000 cells/µL (reference range, 150,000-450,000 cells/µL)

  • Creatinine level: 2.5 mg/dL (reference range, 0.74-1.35 mg/dL)

  • Blood urea nitrogen level: 100 mg/dL (reference range, 6-24 mg/dL)

  • Erythrocyte sedimentation rate: 120 mm/h (reference range, 0-20 mm/hr)

  • Cancer antigen 19-9 (CA 19-9) level: 25 U/mL (reference range, < 37 U/mL)

  • International normalized ratio (INR): 1.1 (reference range, ≤ 1.1)

  • Prothrombin time (PT): 10 seconds (reference range, 11-13.5 sec)

  • Lactate dehydrogenase level: 1500 U/L (reference range, 105-333 U/L)

  • Alkaline phosphatase level (ALP): 140 IU/L (reference range, 44-147 IU/L)

  • Gamma glutamyl transferase (GGT) level: 35 U/L (reference range, 5-40 U/L)

  • Total bilirubin level: 1 mg/dL (reference range, 0.1-1.2 mg/dL)

  • Direct bilirubin level: 0.2 mg/dL (reference range, < 0.3 mg/dL)

  • Alanine aminotransferase level: 40 U/L (reference range, 7-55 U/L)

  • Aspartate aminotransferase level: 30 U/L (reference range, 8-48 U/L)

Later testing reveals a D-dimer level of 0.4 (reference range, < 0.5) and a fibrin degradation product (FDP) level of 10 mg/L (reference range, < 10 mg/L).

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