Instructions
You are a medical student on placement in the emergency department. Your next patient is Achol Mading, 46, who has vomited fresh blood. Her blood results are below.
Take a focused history
Examine the patient
Outline to the examiner:
- Your findings
- Your interpretation of the results
- Your most likely diagnosis and differentials
- Next steps in management, including relevant investigations
Blood tests
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 92 g/L | 115-155 g/L |
| Platelets | 88 x 10^9/L | 150-400 x 10^9/L |
| White cell count | 10.8 x 10^9/L | 4.0-11.0 x 10^9/L |
| INR | 1.5 | 0.9-1.2 |
| Prothrombin time | 17 seconds | 10-14 seconds |
| Activated partial thromboplastin time | 34 seconds | 25-35 seconds |
| Fibrinogen | 2.1 g/L | 2.0-4.0 g/L |
| Bilirubin | 34 umol/L | 3-20 umol/L |
| Albumin | 28 g/L | 35-50 g/L |
| ALT | 68 U/L | 5-35 U/L |
| AST | 142 U/L | 5-35 U/L |
| ALP | 156 U/L | 30-110 U/L |
| GGT | 310 U/L | 5-40 U/L |
| Urea | 12.8 mmol/L | 2.5-7.8 mmol/L |
| Creatinine | 78 umol/L | 45-90 umol/L |
| Sodium | 134 mmol/L | 135-145 mmol/L |
| Potassium | 3.7 mmol/L | 3.5-5.2 mmol/L |