Physician's Assistant

Patient Details

Sdec (258 days ago 09:48)

Sdec Tue 22 July 2025 09:48

Last Modified: 258 days ago

MRN:

Content:

Presenting Complaint:
Upper abdominal discomfort with melaena

Past Medical History:
• Gastroesophageal reflux disease
• Chronic lower back and shoulder pain (occupational)
• Currently taking regular co-codamol for musculoskeletal pain

Diagnosis:
Very unlikely upper GI bleed - more likely oesophagitis +/- gastritis secondary to gastroesophageal reflux disease

I had the pleasure of meeting Alan Tickle in Same Day Emergency Care today.

Mr Tickle is a 47 year-old marine engineer who presented with a 4-week history of upper abdominal discomfort described as a feeling of something being stuck just under the ribs. He reports this feels like a blockage or persistent indigestion that does not respond to Gaviscon nor Omeprazole. Yesterday he developed severe colicky abdominal pain followed by 6-7 episodes of increasingly dark brown stool, prompting his GP to refer him to A&E.

Over the past 3 weeks, he has experienced loss of appetite, fatigue, and weight loss from his usual 67kg down to approximately 65kg, though this appears to be stabilising. He denies any family history of pancreatic or other cancers.

His current medications include omeprazole 20mg OD for reflux and co-codamol 2-4 tablets daily for occupational musculoskeletal pain. He has previously stopped taking naproxen and ibuprofen although has taken these in the past.

O/E: Abdomen soft, non-tender, no palpable masses. Normal ECG.

Investigations:
Blood tests: All normal
ECG: Normal

Plan:
1. Outpatient OGD on GI bleeding pathway (requested)
2. Double dose omeprazole to 40mg OD until OGD (Pt will undertake)
3. Consider stopping PPI and undertaking H. pylori stool antigen testing after OGD

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Patient Details

Sdec Tue 22 July 2025 09:48

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