Problem 35 A 35-year-old woman vomiting blood
It is 7 p.m. on a busy Saturday night. You are called urgently to the emergency department. A 35-year-old woman has been brought in by her husband. She has vomited bright red blood on three occasions over the last 2 hours. The last episode was on arrival in the resuscitation room. The nurses say it was around 500 mL. She is pale but conscious with a GCS of 15. Her pulse is 120 and her blood pressure is 96/57 mmHg. She has an oxygen saturation of 94% on room air.
Blood tests become available as follows:
Investigation 35.1 Summary of results
You organize an urgent endoscopy. The endoscopist finds a large amount of fresh and altered blood in the stomach. No bleeding source is identified in the stomach or the duodenum. Figure 35.1A, B shows the positive findings.
The following morning a definitive procedure is performed. An image taken from this procedure is shown (Figure 35.2).
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