Vomiting Blood

A 55-year-old man with end-stage cirrhosis secondary to alcohol abuse presents around 30 minutes after vomiting a large amount of bright red blood. This is his first such episode.

An endoscopy around a year ago revealed multiple grade IV esophageal varices, which were ligated at that time. He has also been on oral propranolol therapy since then.

His medical and surgical histories are otherwise unremarkable. He has continued to consume half a bottle of whiskey a day, against medical advice.

Select Relevant Investigations
Complete blood count


WBC/DC: 12,000/mm3 (5,000 - 11, 000)
Hb: 10.2 g/dL (12 - 16)
PCV (Hct): 30% (40 - 52)
Plt: 89,000/mm3 (150,000 - 400,000)
Coagulation profile


INR: 1.9 (0.9-1.1)
APTT: 40 sec (normal)
TT: 15 sec (normal)
Ultrasound abdomen


The ultrasound is suggestive of liver parenchymal disease. A moderate amount of free fluid is present.
Liver function tests


AST: 250 IU/L (9-51)
ALT: 135 IU/L (13-40)
ALP: 319 IU/L (34-122)
Total bilirubin: 3.2 mg/dL (0.1-1.1)
Albumin: 2.4 g/dL (3.5-5.5)

Select Relevant Management
Urgent Endoscopy
Transfuse packed red cells