Mr. [**Known patient lastname 7952**] is a 41 yo M with PMH ETOH abuse, cholelithiasis, HTN,
   obesity who presented to [**Hospital3 **] with hematemasis.  He reports
   that for the past 6 years he has been drinking [**2-9**] of a 1.7L bottle of
   vodka daily.  On Friday evening he had several episodes of vomiting of
   bright and dark red material for which he presented to [**Hospital1 **].  
   He had an NG tube which reportedly failed to clear with
   lavage and patient self d/c'd the NGT because he was vomiting around
   the tube.  He was given 4mg IV morphine for abdominal pain, ativan 2mg
   IV for withdrawal, protonix 40mg IV, zofran 8mg IV, octreotide 50mcg
   IV, and 1 unit of platelets. 
   
   In the ED, initial vs were: T 98.6 P66 BP145/89 R16 O2 sat 98% RA. He
   was started on a protonix gtt and octreotide gtt given his elevated
   LFT's.  He was also given a bananna bag.  He had a RUQ ultrasound which
   demonstrated gallstones and sludge and per ED resident report ascites.
   As such given new ascites and abdominal pain he was given levofloxacin
   750mg IV and flagyl 500mg IV reportedly for SBP prophylaxis.  He was
   evaluted by GI in the ED.
   .
   On the floor, he reports that he had two episodes of vomiting of dark
   red emesis.  Per his nurse it was about 75ml and was gastrocult
   positive.  He otherwise endorese RUQ pain radiating to his back.  He
   also reports slow increase in abdominal girth with more acute
   distention and lower extremity swelling over the two days prior to
   admission.

   Physical Examination
   Vitals: BP:153/92 P:64 R: 20 O2: 97% RA
   General: Alert, oriented, no acute distress, no asterixis
   HEENT: Sclera icteric, dry mucous membranes
   Neck: supple, obese, JVP not elevated
   Lungs: bibasilar crackles, no wheezes
   CV: Regular rate and rhythm, [**3-16**] soft nonradiating systolic murmur
   Abdomen:  obese/distended, RUQ and epigastric tenderness to palpation,
   normoactive bowel sounds, no rebound or guarding.
   Ext: warm, well perfused, 1+ pitting edema bilaterally, 2+ pulses
   
   Labs 
   WBC
                                     2.5
   Hct
                                    36.2
   Plt
                                     28
   Cr
                                     0.5
   Glucose
                                     111
   Other labs: PT / PTT / INR:19.1/31.6/1.7, ALT / AST:37/165, Alk Phos /
   T Bili:130/6.9, Amylase / Lipase:145/288, Albumin:2.5 g/dL, LDH:278
   IU/L, Ca++:7.9 mg/dL, Mg++:1.7 mg/dL, PO4:3.0 mg/dL