A 66-yeаr-оld mаle presents tо his primаry care physician endоrsing easy bleeding. He reports that roughly 5 days ago, he began noticing excessive bleeding while brushing his teeth. He has not noticed any bleeding since this event and is currently asymptomatic. He is otherwise healthy with a medical history including hypertension treated with amlodipine and depression for which he takes fluoxetine. On examination, he is well appearing. His skin exam is notable for the finding on his lower extremities (see image). No active bleeding is seen in his oropharynx and rectal exam is negative for occult blood. Laboratory studies are ordered as seen below.Hemoglobin: 15 g/dLHematocrit: 44%Leukocyte count: 7,500 with normal differentialPlatelet count: 35,000Which of the following is the most appropriate next step in management?
A 45-yeаr-оld wоmаn presents tо the emergency depаrtment with hematemesis. Her son said that the patient had complained of gnawing abdominal pain that worsened before and improved after meals for the past 3 weeks. She frequently travels for work and is often stressed. She drinks alcohol socially and does not smoke tobacco or marijuana. She has not had anything to eat or drink for the past 24 hours due to the pain, but coughed up "several cups" of frank red blood before arrival. Her temperature is 98°F (37°C), blood pressure is 80/50 mmHg, pulse is 140/min, respirations are 24/min, and oxygen saturation is 96% on room air. The patient is empirically started on 3 units of uncrossmatched O-negative blood transfusion and pantoprazole. In the meantime, the patient's initial laboratory data results reveal the following:Hemoglobin: 6 g/dLHematocrit: 18 %Leukocyte count: 8,000 with normal differentialPlatelet count: 400,000Serum:Na+: 140 mEq/LCl-: 115 mEq/LK+: 3.2 mEq/LHCO3-: 26 mEq/LBUN: 60 mg/dLGlucose: 104 mg/dLCreatinine: 1.1 mg/dLBlood type: ABRh status: negativeAfter bedside upper endoscopy with stapling of several peptic ulcers, repeat labs are obtained in 2 hours. The patient now complains of "feeling hot" with intermittent shivering. She denies any other symptoms. Her temperature is 101°F (38.3°C), blood pressure is 100/55 mmHg, pulse is 100/min, respirations are 20/min, and oxygen saturation is 99% on room air. Her lungs are clear to auscultation bilaterally, and no accessory respiratory muscle use is observed. No rash is seen. What is the most likely diagnosis?