Patient's chief complaint: Provided by wife: "My husband's very confused and he has been acting strangely. This morning, he couldn't answer my questions and seemed not to recognize me. I think that his stomach has been sweling up again, too. He stopped drinking four years ago, but his cirrhosis seems to be getting worse."

HPI: S.G. is a 46 yrs white male with history of chronic alcoholism and alcoholic cirrhosis. Was admitted to hospital with abdominal swelling and confusion. Unintentionally gained 15 lbs during last 4 weeks. not been sleeping well and has been lethargic, memory issues, and losing temper uncharacteristically.

PMH: pnemonia 9 yrs ago, cirrhosis secondary to heavy alcohol use diagnosed 4 yrs ago with ultrasound and liver biopsy, H/O uncontrolled ascites ad peripheral edema, H/O two upper GI hemorrhages from esophageal varices, H/O anemia, H/O E. coli induced bacterial peritonitis 4 yrs ago, H/O acute pancreatitis secondary to alcohol abuse, No history to suggest cardiac or gallbladder disease, No previous diagnosis of viral or autoimmune hepatitis

SURG: S/P appendectomy requiring blood transfusions 30 yrs ago, S/P open reduction internal fixation of right femur secondary to MVA 5 yrs ago

FH: Father died at age 52 from liver disease of unknown etiology, mother had rheumatoid arthritis and ulcerative colitis, died from massive stroke at age 66, maternal aunt (age 71) with Graves disease, patient has no siblings

SH: H/O ethanol abuse, quite 5 yrs ago following MVA, previously drank 3 cases of beer a week for 15 yrs, H/O IVDA (heroin) and intranasal cocaine, quit 5 yrs ago, prior smoker (1/2 ppd for many yrs)

Meds: Propranolol 10 mg po TID, Spironolactone 50 mg po QD, Furosemide 20 mg po QD, MVI 1 tablet po QD, Occassional ibuprofen or acetaminophen for headache, patient has H/O non-compliance with meds

Allergies: NKDA

ROS: increasing abdominal girth

Required:

Hematemesis and tarry stools are clinical signs of which serious potential complication of cirrhosis?