MSFinals-0908

MSFinals-0908

A 47-year-old female collapses at home and is referred to the medical team. She has had two episodes of haematemesis in the emergency department, but no melaena. Her family denies any history of alcohol excess, and she has been otherwise healthy.

Upon examination, the patient appears pale and sweaty with a pulse of 110 bpm. Her lying blood pressure is 95/60 mmHg, which drops by 30 mmHg systolic upon standing. Palmar erythema, purpura, and spider naevi are noted. There is no hepatomegaly, but a fullness is present in the left hypochondrium.

What is the appropriate course of action for this patient?