Step 2

Gastrointestinal 4

A 64-year-old man presents to the emergency department following a week of worsening confusion and abdominal pain. He reports a month of worsening fatigue and malaise but has no other symptoms. Past medical history includes hypertension, gout, and frequent presentations to the emergency department with alcohol toxicity, although he denies recreational drug use. His temperature is 37.8°C (100°F), heart rate 104 beats/min, and remaining vital signs are within normal limits. On physical examination, his Glasgow Coma Score (GCS) is 14 (Eyes 4, Voice 4, Motor 6) and he appears extremely jaundiced. Abdominal examination reveals distension with generalized tenderness, evidence of free fluid, and hepatomegaly.

Given the most likely diagnosis, which of the following findings would suggest an impending life-threatening cerebral complication?

  • A) Coarse respiratory crackles
  • B) Elevated prothrombin time (PT)
  • C) Hyperammonemia
  • D) Hypotension
  • E) Irregular breathing


Octavi Casals Farre


Dr. Ted O'Connell

Last updated

Nov 05, 2022

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