Physician's Assistant

Rapidreview Fri 07 November 2025 16:27

Last Modified: 150 days ago

MRN:

Content:

80-year-old gentleman presenting with intermittent melaena over several months.

Social History:
Cares for his wife who is bed bound. Previously had a package of care which was cancelled by the patient, frequency unclear. Awaiting social services input.

Past Medical History:
• Ischaemic heart disease
• NSTEMI 2019
• TIA
• Hypertension
• Mitral and tricuspid regurgitation
• Spinal stenosis
• CKD 3a
• Heart failure with reduced ejection fraction (EF 26% August 2022)
• CABG
• Interstitial lung disease
• Atrial fibrillation

Presenting Complaint:
Intermittent melaena for several months. Patient has worsening exercise tolerance, does not leave the house, walks around house only with stick for 50-100 yards.

Investigations:
Raised inflammatory markers, probably secondary to infection.

Assessment:
Slow upper GI bleed, intermittent. Likely would benefit most from treatment with PPI rather than endoscopy in the first instance.

Plan:
• Further resuscitation as required
• IV PPI therapy
• Endoscopy once stable, aiming for early next week
• Continue aspirin due to previous CABG
• IV omeprazole BD

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Summary:

Investigations:

Rapidreview Fri 07 November 2025 16:27

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