15.A 56 year old woman, who fell and fractured her hip, is admitted to the orthopedic surgery service for open repair. The patient has widespread bony metastases from carcinoma of the breast and has controlled her pain with hormonal treatment with tamoxifen and codeine every 4 hours. You are called to see her by the orthopedic surgery resident 12 hours after the operation because of her complaints of severe diffuse pain. 20.For three months, a 62 year old man has had epigastric pain occurring within one hour of each meal and unrelieved by antacids. Twenty years ago, he had a vagotomy and pyloroplasty for a bleeding duodenal ulcer and was asymptomatic before the current illness.
Physical examination is normal except for mild tenderness in the epigastric region.
63 year old man develops jaundice one day after having partial gastrectomy for massive upper gastrointestinal bleeding secondary to hemorrhagic gastritis. He had received 10 units of packed erythrocytes during surgery. There is no previous history of liver disease. Physical examination shows jaundice. The abdomen could not be examined adequately because of the surgical wound.