Case Abstract Ruilan, li Female 65y From: Department of gastroenterology 06/01/2006

Chief complaints  Intermittent hemorrhage in gingival mucosa for one year, epigastric bloating for two weeks and hematemesis for six days

History(1)  Intermittent gingival bleeding for one year, usually during brushing teeth, without rhinorrhagia, petechia, ecchymosis, hematuria,hematochezia, and melena. No therapy.  Middle and upper abdominal floating for two weeks ， accompanied with nausea, no relationship to meal ， without heartburn ， vomitting ， abdominal pain ， hematochezia, and melena. The symptom could not resolve after using Motilium.

History(2)  Hematemesis occurred after taking hot food six days ago, for four times, about 1000ml; accompanied with nausea, vomiting, dizziness, palpitation, fatigue and diaphoresis.

History(3)  At emergency room  Vital signs stable  CBC: WBC 10.09*10^9,Hgb 101g/l,Plt 77*10^9/l  Biochemistry: ALT 35 U/l, Tbil 0.9mg/dl  PT+A: PT 16.3s  Alb: 2.5mg/dl  HbsAg(+)  Ultrasonic: spleenomegaly, no abdominal effusion

History(4)  Treated with transfusion, anti-acid, somatostatin at emergency room.  No hemetemesis any more.  Endoscopy: esophageal varices, no active bleeding; chronic gastritis

 Past history: deny hepatitis or parasite infection.  Personal history ： deny alcohol abuse, cigarette.  Marital and menstrual history: no special.  Family history: one daughter HbsAg(+).

Physical examination  vital signs:BP 125/60mmHg, P 85, T 36,R 20; varicosity on abdominal wall, spleenomegaly ， pittable edema on both legs ， palmer erythema (-), spider angiomata （ - ）， shift dullness （ - ） ， flutter trembler （ - ） ， normal on psychological and mental test

Primary diagnosis  Upper gastrointestinal bleeding esophageal varices rupture Chronic hepatitis B hepatocirrhosis esophageal varices spleenomegaly Child B Chronic gastritis