Dr. Frank J. Gallia: This 51-year-old man entered the hospital with a history of epigastric pain, dark stools for several weeks, and a one-week history of vomiting small amounts of dark red blood. His history included a generous alcoholic intake and a recent 25-lb (11.4 kg) weight loss. He had recently had incision of a painful right shoulder; a culture of the fluid revealed both staphylococcus and streptococcus. Physical examination revealed a febrile, thin man with a grayish hue to his skin. There were dark deposits on the sclerae of both eyes.
Laboratory data included a hematocrit value of 18%; amylase, 48 units/ml; prothrombin time, 50%; ammonia, 100μg/100 cc; blood urea nitrogen (BUN), 9 mg/100 cc; creatinine, 0.6 mg/100 cc. An upper-gastrointestinal-tract series was done.
Dr. Laurence L. Robbins: Dr. Tomchik, do you want to make any comment?Dr. Frederick S. Tomchik: The proximal stomach does not seem to
Wittenberg J. Gastrointestinal Bleeding and Arthropathy. JAMA. 1966;195(12):1048–1050. doi:10.1001/jama.1966.03100120116032
Customize your JAMA Network experience by selecting one or more topics from the list below.