Case history
Case history
A 50-year-old man presents to the emergency department with a history of black, tarry stools but denies hematemesis or abdominal pain. His family has noticed progressive confusion. He has alcohol-related liver disease with cirrhosis. His heart rate is 112 bpm and blood pressure is 105/66 mmHg. He is jaundiced and lethargic, is oriented to person and place but not date, and has moderate ascites. Neurologic exam reveals asterixis, and stool is positive for occult blood.
Other presentations
Some patients may have previously undiagnosed chronic liver disease. Others may present with acute liver failure. Dilated pupils and a comatose state should raise suspicion for cerebral edema. This presentation of cerebral edema is very rare in the setting of cirrhosis and HE and should raise the suspicion for acute liver failure.
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