Case: Abdominal pain, Malaise and bruise on the leg

History of present illness and examination

A 44-year-old man with a history of HIV, hypertension, diabetes, gastroesophageal reflux disease, thrombocytopenic purpura, and hepatitis c present to hospital emergency department with generalized abdominal pain, malaise and bruise on the left inner shin, and subjective low-grade fever. He denies any trauma that might have caused the bruise. He also denies vomiting, diarrhea and other complains.

Upon examination, vital sign’s were normal, but patient temperature were slighty elevated at 99.4 degee centrigrade. Physical examinations was normal save for diffuse mild abdominal tenderness and a single are of bruishing on the lower leg (figure)

Laboratory examinations identified elevated liver function test- which is consistent with patient’s history – and a normal lipase level. White blood cell count was normal and platelet count was 85 × 103/μL chem.-7 revealed a glucose level 0f 250 mg/dl ND CREATININE LEVEL OF 1.6MG/DL

The patient was given an antacid orally but experienced minimal improvement in his abdominal pain?

What additional laboratory test should be considered?

What treatment option would be suitable for the patients?

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