A 55-year-old mechanic was admitted to hospital because of severe epigastric pain and repeated episodes of vomiting of blood (hematemesis). His blood pressure was 90/40 and his pulse rate was 120/min. His appearance was somewhat un-kept. Upon questioning his drinking habits, he reported he often went on "binges", sometimes drinking a quart of alcohol within a few days. The patient revealed that he had exhibited upper gastrointestinal bleeding on previous occasions, but never so profusely.
The patient's skin and conjunctivae were slightly yellow (jaundiced). His eyes appeared to be slightly sunken. His abdomen was enlarged and rounded, giving the appearance of being “fluid filled.” There was protrusion and considerable downward displacement of his umbilicus. Palpation of the patient's abdomen revealed his liver measured 14 cm in the mid-clavicular line, indicating an…
