CASE 15

PATIENT: 51-year-old man

CHIEF COMPLAINT: This patient was admitted with a history of chronic alcoholism. At the time of admission, there were mental as well as physical signs of liver failure. Immediately before admission, there had been an episode of massive gastrointestinal bleeding.

MEDICAL HISTORY: The patient had been hospitalized on a number of occasions because of liver disease. He had a 20-year history of ethanol abuse.

FAMILY HISTORY: Noncontributory

DRUG HISTORY: The patient had taken multivitamins and Tylenol (acetaminophen).

PHYSICAL EXAMINATION: The patient was a jaundiced, disoriented man. He was febrile, with a temperature of 105^oF. Apparently, the jaundice had begun approximately 3 weeks before admission. There was marked ascites and ankle edema, and numerous ecchymoses were noted over the abdomen and arms. The blood pressure was 140/80 mm Hg, and stools contained blood.

LABORATORY RESULTS

	Patient	Normal
Prothrombin time	19 seconds	8-11.5 seconds
aPTT	52 seconds	24-37.5 seconds
Platelet count	50,000/μl	150,000-350,00/μl

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