Physician's Assistant

Sdec Sat 28 June 2025 09:58

Last Modified: 282 days ago

MRN:

Content:

Presenting Complaint:
Abdominal pain, headache, and melaena

Past Medical History
• F+W

Diagnosis:
Suspected peptic ulcer disease secondary to concomitant aspirin and naproxen use

I had the pleasure of meeting Mr Fitzgerald in Same Day Emergency Care today.

He presented with a 2-month history of abdominal pain and headaches. Initially seen in A&E where he was diagnosed with migrane and commenced on naproxen and aspirin 900mg daily. Over the past month, his symptoms have persisted with significant abdominal cramping pain and frontal tension-type headaches described as a tight band around his eyes. He denies fever, visual changes, or other neurological symptoms.

Most concerning, he developed jet-black tarry stools that were difficult to flush, prompting attendance via 111 advice.

He is a computing student about to progress to cyber security degree, he reports no significant life stressors currently.

On examination, he was nauseated with dry MMs. Other examination was unremarkable.

Investigations:
CT Head May 2025: No acute intracranial abnormality
Bloods June 2025: Salicylate levels undetectable, lipase normal, FBC normal, U&E normal, LFT normal

Plan:
1. Discontinue naproxen and aspirin immediately
2. Bloods incl G+S
3. Upper GI endoscopy - timing dependent on GBS
4. Commence PPI
5. Antiemetics
6. Review blood results and determine inpatient vs outpatient management
7. Analgesia - Paracetamol

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Summary:

Investigations:

Sdec Sat 28 June 2025 09:58

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