A 58 year-old woman with no past medical history presents to the emergency department with a 3-day history of epigastric discomfort. She attributed this to gastric reflux and tried Tums and Maalox with little relief. A right upper quadrant ultrasound showed new portal vein thrombosis. She has a past history of basal cell carcinoma, which was surgically resected. There is no family history of blood clots or other hematological conditions. She works as a nurse. She is not taking any medications and she has no known allergies.

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