A 45 year old man presents in the Emergency Room with a two day history of black

Question

A 45 year old man presents in the Emergency Room with a two day history of black covered stools and recurrent nosebleeds. His history reveals both a recent as well as past history of ethanol abuse. His coagulations studies reveal:

Platelet Count:                       60,000/cumm

PT:                                          20 sec

APPT:                                      52 sec

Thrombin Time:                    11 sec

Fibrinogen:                            201 mg%

FDP                                         greater than 40 ?g.ml

1. What is the probable diagnosis?

2. What additional tests should be performed to confirm the diagnosis?

Explanation / Answer

Black Stools from Nosebleeds: While it's not very common, it is possible that a nosebleed can result in a stool that appears black. A very severe nosebleed that results in a person swallowing a lot of blood could cause black stools. The blood makes it all the way through the digestive system and appears black or dark by the time it is eliminated from the body.

Alcohol (Ethanol) is known to be toxic to liver cells, known as hepatocytes, and it causes inflammation of the liver. The effect of alcohol on hepatocytes is immediate. Repeated high levels of exposure to alcohol causes chronic and continuing inflammation of the liver, which causes the development of scarring to the liver. This scarring is the beginning of alcoholic liver disease. Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases. Cirrhosis occurs in response to damage to your liver.

The symptoms of alcoholic liver disease vary based on the severity of the disease. Commonly reported symptoms include:

* Nausea and vomiting
* Abdominal pain
* Jaundice
* Bloody or dark bowel movements
* Nosebleeds or bleeding gums

Diagnosis:

Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical conditions show a damaged liver.

To test for liver disease, your doctor might recommend:

Liver function tests

Blood tests (A blood test may also look for signs of abnormal blood clotting, which can indicate significant liver damage).

Further testing: Imaging tests

Scans may be needed to produce detailed images of your liver. This may include:

An ultrasound scan

A computerized tomography (CT) scan

A magnetic resonance imaging (MRI) scan

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