Black stools on the surgical floor

A consult: day 2 after hip surgery, a cirrhotic patient has melena and a hemoglobin drifting down.

63-year-old manOrthopedic ward (medicine consult)Fictitious educational patient

Child-Pugh B cirrhosisDay 2 post hip hemiarthroplastyOn prophylactic enoxaparin

Day 2 · 11:20

The consult question

"Medicine consult: melena x2 this morning, Hb 84 from 102 yesterday. Cirrhosis history. Please advise re: bleeding and anticoagulation." First move of any consult: define the actual question and see the patient.

Vitals

HR104BP106/62RR18SpO296%T36.9

Examination

General: Pale, alert; spider nevi over the chest.
Abdomen: Soft; mild distension, shifting dullness; no peritonism.
Rectal: Melena on glove.

The consult asks about anticoagulation. What is the consult really about?

Answer the question above to continue.