So richard patterson 37 year old man alpha089958 investigations ogd december 2024 poorly tolerated normal appearance of the esophagus stomach and duodenum ct abdomen and pelvis december 2024 mild but premature diverticulosis affecting the descending and proximal sigmoid without acute features w glial fatty deposition in the descending and transverse nonspecific finding no other bowel pathology small uncomplicated umbilical hernia no cause for symptoms identified bloods 06/27/2025 crp less than 1 creatinine 62 urea 1.4 tidal protein 88 with albumin 54 alt 74 previously 42 lipase 33 full blood count normal ttg tested november 2024 negative so presented to the surgical assessment unit on the 06/27/2025 with upper abdominal pain diagnosed with gastritis and discharged with upper gi surgical follow-up urgently can you me sorry I don't have any any chairs no you're fine yeah I've got a bit of my left is this yeah moving no it's I know just both of my feet you I'm just gonna keep you I'll wait okay thanks for your time let's do it you sit down I'm sure you haven't sat down you sit down no no I sit down all day honestly it's fine I know so I'm not going to actually detain because every time I keep forgetting it's is that alright yeah I've had so I'm 1 of the gastroenterology doctors I'm 1 of the medical doctors that do the same kind of stuff as the surgeons yeah that you saw the other day with the tummy pain very well yes lost weight mhmm vomiting it's not like a belly ache in the military mhmm back pain last year quite severely and he was on a lot of codeine yeah codeine yeah whether that's made him have ulcers or something inside because not normally ibuprofen does but now you see I stayed away from that because that would irritate me yeah but so say mri and things is it an mri or had a ct ct scan there was initial it wasn't abscesses but it was some sort of thing that would pouchings on the bowel like wear and tear changes so they said there was little pockets of things that would say the same but wouldn't necessarily cause problems exactly yeah it's probably coming for all of us those wear and tear changes it's called dilated so that's what they said to him on friday but obviously the pain is moving to his chest now and even with the sickness that's done nothing for now either so tell me about your symptoms they started years ago no it's probably well I've been on that band to go and it was just not but your test for the celiac disease was normal I've been tested november was not oh yeah blood test I never got someone's test yeah yeah and it showed nothing on that was normal yeah your test for celiac disease was oh okay yeah then yeah I just kind of like dealt with it when I was away right and he's not he's just I feel very dehydrated even though I am drinking water right but I can have patient 1 minute diarrhea and that so and so going back to your symptoms so you said you've been on lansoprazole for about 6 years yeah and what are your symptoms that was for acid reflux okay so what are your symptoms so oh well I haven't felt it for so long because I take 2 drugs good but yeah that was like pain coming up here but it was like almost an indigestion like a burning pain did you get fluid coming into the back of your mouth yeah you they almost taste it sometimes yeah you taste the acid yeah do you ever get food coming up into the back of your mouth I know when I vomit in yeah it's fine but not sat on the table after a meal and you've noticed something coming into fat not like that that's fine okay that was 6 years ago you're having some heartburn symptoms yeah so then they decided on the antacids the amethrazole but that wasn't that has and then I really haven't had any that's I've dealt with any acid reflux when did they sit you for omeprazole alone when I went back just before deploying and I started getting on with getting doing the biopsies because no 1 told me to stop taking the lansoprazole that's when doctors in the dockyard moved me from omeprazole to matt thompson okay fine because you were still getting symptoms then I just wonder what they said yeah well I was saying that started like right now and vomiting started okay I don't know if they thought it was something to do acid reflux so he said oh I can change that to benzodiazepine vomiting started maybe november time when you came in for that ct scan is that fair to say yeah I from that then yeah november 2024 yeah so next year and then yeah and tell me about the vomiting so you vomited at night yeah so it always kind of like was lying down and then if I got mhmm and then when it went went away it was well it's got worse mhmm several hours sounds terrible it could be like really you know yeah so I get blood going to the bathroom I feel sick that's why do it can't remember it's a horrible symptom in the last few days it's like red as well as yeah there's blood in the other day what color I took a photo oh yeah alright so the so vomiting at night that started in november and it's gradually increased over that time now it's just like constant and now that this pain used to go away let's say now it doesn't come on to the pain then the vom so then the vomiting has got worse over the last week yeah yeah and we went to leave the house so we were up at 8 x 9 he was in at like 2 and 5 no so let's just have 1 it doesn't look bright red to me it looks like sick pinky peachy colour that looks like blood to me did it look like the colour of your t shirt obviously you don't know with photos would say it's a lot brighter than it did in the photo yeah okay fine because I wouldn't look at that and think blood I'd look at that and think but if but you never know photos don't sometimes do adjust it's not really the best for them no that's alright so yeah now it's now it's so then thinking about the pain is the next symptom when when did you first notice the pain the upper tummy pain I've healed a pain in the stomach whichever pain the pain in the stomach I've kind of always had I'd wake up feel nauseated yeah and go to be sick and you have to make yourself sick to try and make the pain better yeah many times a day and you said you can't even really get out of the house because you're vomiting so much how many times long ago we're still talking come out 1 under the other yeah okay we're still talking like 30 + times a day how much weight have you lost think probably about 10 kilos you're not particularly big guy you haven't got huge amounts of leads you can see how much he's weighed and his stomach is very swollen all the time feel bloating massively he left sometimes and it can really get changed like from 1 have you got it now now it is yeah yeah yeah constantly yeah it's not really subsided can you just write it again I think it's quite it's always there like it goes up and down but yeah it's quite an intense and like it's not it's not quite an intense problem yeah yeah if that makes sense mhmm dull ache in the a double a dull ache in the upper tummy that's there the whole time but it does kinda better and get worse and just vomiting or opening your bowels make it better yeah it's supposed like yesterday I was it really hurt that like when you were in my eye and then after that you've been taking anti sickness since friday which cocodol yeah but yeah choline and parasite yeah think they did wanna be first to make it since friday like he's the hoe of him like his he's just looked we're on the way to the beach and we turned around because he felt that unwell yeah so we tried to get out today to have a bit of normality at toilet and then I just said this thinking about your your bowels see they're coming out the 1 end of the other tell me about your yeah so I I think it would be you know you can be constipated again yeah so within a week you'll you'll flip day to day between the constipation the weekly yeah okay I can have constipation in the morning and by constipated what do you mean just you know you need to go taller yeah want go can't like push it out and what cut your teeth and grab onto the toilet or yeah does it's like a big yeah yeah but and it's like rock solid yeah it hurts coming out yeah yeah and then afterwards you've literally got the last time you had a normal bowel motion it's a whole long because your whole for a long time for a long time yeah yeah fine yeah and when you go to the loo mhmm and open your bowels how quick does the pain come back does give you a bit of relief yeah you're on some codeine which probably doesn't make things no no in terms of the bowels any better no have you been more constipated since you had that or was it not yeah I've taken I've got a more forefoot back how long have you been taking cagodemol for so this time only from friday when I prescribed it I was on it for god like year or so before really do you think that did that make your symptoms worse at all when you're doing it no see I'm I'm talking so when I just back back pain yeah I didn't have all of reasons fine but you said you had the reflux 6 years but you didn't have the tummy pain no no no and with you please that's only really started in the last that got better didn't it and does eating make the diarrhea or the vomiting when I eat something you know it gives the stomach something to come up yeah sometimes my vomiting can be just be like lemon or broth or oil yeah yeah how quickly will it come up I think right when I get start feeling unwell it could be that meal that meal yeah yeah taste it you know I taste this and that I've eaten I've not slept the full night for that bad that he's waking me up if you said that last time I had like a good 8 9 hour sleep before yeah and you're in the military yeah I've just been in middle east where have you been if you know what mean did you blow out that yeah you were ill with this but yeah in real time I just dealt with it yeah because I had to go and do 1 day you were in bed weren't you you're quite yeah but they sort of treated you but he didn't oh and I fell out bed they did all your robs and everything you were checking on you yeah see I wasn't sure if that was like you know I did feel feel really ill I felt really sick then so whether that was maybe a flare up and then maybe yeah what with the military has being away correlated at all with the start of these symptoms no where you weren't away just before you had picked I was home for a couple years and we had bug going away from the family yeah it's 4 months out family yeah yeah yeah yeah they were 3 of them yeah yeah right no bowels running in the family peri was on omeprazole okay once upon a time then they diet I can't say the first thing is that hereditary I don't know I think there probably is a complex inheritance it's not the only thing really wrong his mom's got diabetes can I have quick look at you look at your hands and your chest and your tummy and all that kind of stuff you lie down a lot just sit up and down perfect I'll see your hands to start with that's okay thank you I'm take a look at you turn it over for plastics and that isn't and she's an indoor cat anyway okay so she doesn't have any she's treated with all her vaccinations to her that's lovely mama nice nice nice 1 nice just have a big breath for me in the mirror not really clear yes would you mind laying down for me 3 minutes fine do you drink or drink vape and beer vape fine and how much do you drink like 25 25 you got a little salt or any more than nothing yeah fine why tell me about that no anything like that sorry I always keep it in the way just to yeah relax you know we get it at home so so how many beers are you having at each day I'll give you a couple you can always have a glass yeah yeah yeah drink so you have to put it some cup of your beers so you can just flash away 4 cans at night because you'll do a whiskey which has been in there with all the blood now okay sometimes that can be a coping mechanism for him because he will cause pain yeah yeah yeah yeah understand and he feels that if he has like a cider then it can survive but fine he can come back put it away yeah therefore yeah yeah so 5 pints 5 cans a night is that a pint can yeah you could do yeah or a couple of pop that some spirits and how often would you buy them not always spirits sometimes not always recently yeah how often would you buy like a bottle of spirits like that bottle of rum that you drunk drunk within yeah it's not it's not like I said mugarhoe bottle no but it was on yeah but yeah it was over a couple of days yeah fine you're having a uvula in that for not that as you can remember just drinking occasionally no not all of it as I would say oh obviously you've not had any scans now what you describe when something affects multiple systems like this think whether you're getting bad reflux and you've got bad bowels I think sometimes the simple answers are the good ones you imagine yourself as just a tube you put things in the top no matter what you put in the top if things can't come out the bottom it's gonna back up and it's gonna cause you discomfort it's gonna cause you abdominal pain being really constipated because the bowel stretches and that's the only pain sensation you have in the bowels when it stretches out and also you can get terrible reflux because things can't leave your stomach and you have to warm them back up you're really constipated definitely doesn't help I don't know if it's causing all your symptoms but it definitely won't help the booze won't help it really irritates your stomach have had a drop in the last 3 days that's good scattered yeah that's fine because that I mean that stuff is so acidic especially sucker it's directly acidic and also the alcohol has a directly toxic effect irritating your last chandoscopy you didn't have any signs of it you didn't check the most fantastic views my tipi mint I understand you when you're drinking you build up your tolerance and okay so we might even be normal doses that might not you know push out but the it was a good amount of sedation but it's just you build up your tolerance in the drink yeah I didn't really feel any difference from the first time fair enough it's all about what we've done in the last few months oh okay yeah no we can go bit in the last few months your liver's ready for it it's like oh for a bite your liver's all your enzymes are getting and then when you have the sedation your liver's ready it can just accumulate very quickly and you haven't been drinking in the last few months that much but anyway but by the by we didn't get the most fantastic views we weren't able to take any biopsies there's the potential of a bug in the stomach an infection in the stomach called h pylori causing a lot of your stomach irritations think that when you've got all of these symptoms there's probably not gonna be 1 thing yeah that fixes everything but often I find getting everything better and making sure everything's sorted is the best way to get you feeling better getting your bowels moving better with good regular laxatives that you take on a regular basis not struggling with it's gonna be really helpful trying to work out whether there's a bug in your stomach cutting down the alcohol all those things as a gastroenterologist I have lots of tests some are horrible like endoscopies but they do give us really good information if you have episodes of possibly bringing things up that are blood looking will be really helpful to see whether there's anything that you might have brought up that's got blood in yeah or whether you know and if there's anything bleed coming yeah and just make sure there's no inflammation in your stomach generally not gonna book that for you in the next few days on 1 of the well have you had any blood tests friday he did friday said that in the blood gases he had an infection yeah white cells were high but they go up when you vomit alright but the other markers of infection the crp was quite low so for me I looked at those and thought oh you've been vomiting did they give you antibiotics no not didn't they're probably the right guess not a huge amount of yeah because that was sau we saw the other day yeah think it wasn't specialist yeah yeah so well yeah they are they're very good at dealing with tummy pain abdominal pain and surgical pathology but mhmm people like yourself with problems from multiple areas usually come to see us so for the possibility of bleeding I suggest you do an upper gi endoscopy and get some blood tests today make sure your blood counts haven't dropped if they have dropped then you need to stay in hospital for that test if they haven't dropped then you can have it as an urgent outpatient test the good thing about having that will be you'll be booked on 1 of the doctors like our solicitor 1 of the nurse sent us this last time we can give you more sedation we can make sure you're quite sleepy I've taken the lactoxazole as well it's irrelevant I think you can stop it but your symptoms will probably get worse scares me like stop taking it yeah exactly if you stop the zansoprazole for 4 weeks we can take a biopsy from your stomach and show whether you've got this bug h pylori or not but your symptoms going to be much worse for the first few weeks for the first week after stopping it really it probably doesn't help us that much the acid reflux system come back exactly and the acid reflux will go back so I suggest we just eradicate that bug just in brief even assuming it's positive because we're not going get a good test for that h pylori just to see whether and starting with laxatives just trying to get everything moving from the bottom end and try and tackle everything that sounds brilliant so we're just thinking about where we are like today yeah of course obviously I want to start feeling well ask them to get some blood tests and put a drip in ask them to give you a drip blood test come back we can make a plan about whether they stay in hospital for a camera test and we get out of here and come back for a camera test on monday or tuesday bit more of an answer I'll get you a couple of weeks after some lectures he's obviously vomiting mhmm if you're gonna give him a more hour they're come fly up yeah yeah yeah that's that's probably what's happening the anti sickness and within 15 20 sick mhmm so then we had to wait because we don't know how much he digested in his blood to then take the next lot mhmm that's the only problem I mean your plan sounds fantastic but yeah yeah no I appreciate it I sip I sip water I should I should because if I if I jump out in the next 10 minutes a bottle water yeah I would I'd be sick yeah my only concern now is that of course I understand that yeah yeah thought sorry to no no it's and that's that's why I feel so dehydrated is because I can't is it works because the antibiotics are in the stomach the antibiotics they might work the same it works because you take tablet antibiotics and the infection both antibiotics you need to get up to where the infection is so how will we deal with that then if you stop your stop your vomiting in order to get that sorted vomiting's probably a few things there's probably an element of dyspepsia functional dyspepsia can happen because people get very constipated the camera test will tell us how if they're on some strong anti sickness medicine but it's not when's the last time we went for a pee a good pee this morning and then something came out yeah yeah so that's when I was constipated yeah so yesterday I thought I'd make I actually managed to it stayed in and then this morning I had a appointment after the constipation was it's about 4 5 miles was it so no I had a that's small okay yeah and I had a good bowl also mhmm and I had some gluten let's try and get on top of your vomiting with that gastritis thing and some anti sickness through a drip in a and e if we can get on top of it fantastic if not then you need to commit to hospital for us to make whatever it takes to stop it yeah of course I'm like this that's why I'm back today yeah well work here so I'm like yeah yeah what did do plastics fine what did you do in plastics I'm on trauma yeah yeah so do like minor ups and things I've worked online I've worked for like 11 years oh nice fine and where do you work I'm in gastroenterology yeah oh yeah because you got maternity sometime over there sounds like it don't come over at your end of the building very often holy shit it's lunch it's only I've had 1 patient under you guys actually right you may cross pass again I'm sure you will do you know any of my colleagues no I don't know if I do I never really go down there I know david peverdy he's a good friend of mine yeah yeah oh yeah I've got a good friend yeah foundation years together oh that's so your standard is as good as as well as his then I don't know what's his standard very good really good yes yeah that's good to because he got married recently didn't he he did lucky I was go on side no I didn't okay no no no it sounds like a wedding was yes he's just had to reapply for the job because of the ridiculous isn't it no need so many good so are you registrar then yeah yeah so you've got your number is it the same in plastics as it is in your specialty it's probably not as competitive in mine I think it's all all applicants to place so I don't know what we're oh we have I mentioned that I met you rob yeah yeah yeah quite a bit do you and let him on up together yeah yeah yeah that's nice great so we're we've got a bit of a plan okay yeah yeah it's on us thank you very much for your time anything I've missed anything I've forgotten no no so we'll just wait for wait yeah yeah I'll ask them to get everything sorted out for you I guess the other option is I could bring you a medical aesthetic and do it how did you find those aesthetics because we're trying to get 1 0 yeah we have a fax from yeah how'd you find it for I don't know helpful my thing but the acute medic seems to like it it's another place to sort people out isn't it yeah true I'll see what they're doing if not I'll ask them to bring you a chest x-ray yeah thanks a lot alright thank you very much nice to meet you greg thank you have a good day note recent investigations with elevated alt so impression is most likely functional gut symptoms with ibs with predominant constipation and or functional dyspepsia being strong possibilities end stop however severity of symptoms warrants further investigation particularly in the context of elevated liver function tests and recent travel plan bloods including noninvasive liver screening ttg h b 1 c thyroid function testing vitamin d consideration upper gi endoscopy with small intestinal biopsies to exclude whipple's disease actually don't write that just small upper gi endoscopy with small intestinal biopsy and also assess for cause of possible upper gi bleeding and they're in the impression low possibility of upper gastrointestinal bleeding most likely mannery weiss tear in the plan bloods group and save catconnect glasgow blacksmith score to determine inpatient versus outpatient ogd plan unable to unlikely to be able to tolerate cessation of ppi therefore empirical h pylori eradication for 2 weeks iv ppi iv fluids ultrasound of the liver if lft is persistently abnormal just do an ultrasound of the liver laxatives