Patient is a 46-year-old man who presents with the following symptoms: dark urine, jaundiced skin and eyes, swollen belly, fatigue, weight loss. He also reports a fever over the past several days. The patient has a past medical history of hypertension and after some questioning; he reveals he is an IV meth user. He also acknowledged that he tested positive for hepatitis B several weeks ago but

declined treatment. He hid his disease from his family, even to the point of wearing sunglasses constantly so they would not notice that his eyes were jaundiced. He admits to still injecting meth.

Physical exam shows his liver is enlarged and almost hard to the touch. Ultrasound of the abdomen show a markedly cirrhotic liver. Blood work shows elevated liver enzymes. While assessing the patient, he started bleeding from his rectum. The plan was to admit the patient, but once the rectal bleeding started, he started bleeding out from every orifice, including his eyes and mouth. He went into cardiac arrest and could not be resuscitated.

Dx. Cirrhosis of the liver, acute hepatitis B; IV drug abuse, cardiac arrest

First-listed diagnosis: ________
Secondary diagnoses: ________
Fill in the blank with correct word.

First-listed diagnosis: ________
Answer: Cirrhosis of the liver – K74.60

Secondary diagnoses: ________
Answer: Acute hepatitis B – B16.9; methamphetamine abuse – F15.10; cardiac arrest – I46.8