PRESENTATION 2: NOW – Thursday, Dec. 19
By Shakirat Salvador, MD
Clinical Gastroenterology Fellow
Vanderbilt University Medical Center
Patient is a 61-year-old M with history of alcohol abuse (no cirrhosis) who initially presented to the emergency room (ER) with sudden onset abdominal pain. He does not use NSAIDS. Lab showed total bilirubin 2.3 (0.2-1.2mg/dL), alkaline phosphatase 216 (40-150 unit/L) , AST 465 (5-40 unit/L), ALT 315 (0-55 unit/L), hemoglobin 12.5 gm/dL (baseline). CT without contrast and MRI showed pancreatic duodenal artery aneurysm. He was discharged. However, his abdominal pain returned in addition to new onset melena. On arrival to ER, blood pressure was 85/56, heart rate 94, respiration rate 17, 96% on room air. Labs showed total bilirubin 6.3 (0.2-1.2mg/dL), alkaline phosphatase 183 (40-150 unit/L), AST 204 (5-40 unit/L), ALT 287 (0-55 unit/L), hemoglobin 8 gm/dL.
What is/are the next step(s)?
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