Mr. Bullroar didn't fair so well. 

• On account of his cirrhosis and the hepatic vascular reorganization with increased vascular resistance, he had developed some impressive esophageal varices.
• While his doctor was trying to insert a nasogastric tube, one of the varices was lacerated.
• The increased hepatic portal blood pressure resulted in a massive hemorrhage and he became hypotensive.
• They could almost not get the bleeding stopped.
  • Lousy clotting proteins due to low vitamin K.
  • Portal hypertension to boot.
• He received 8 units of blood, plus extra fluids, but still went into hypovolemic shock.
• The extended period of low blood pressure resulted in the death of his renal tubular epithelium. He is now in acute renal failure and his prognosis is not good.

It remains to be seen if Mr. Bullroar will survive, but his immediate care, including nutritional supplmentation will be critical to the outcome.

Let's sum it up and then take a little quiz.