So barry hughes 78 year old man presenting with melina and syncope 1 4 6 3 9 9 4 blood tests hemoglobin 79 white cells 16.5 low red cell counts red red blood cells 3. 2.34 I should say mcv 1 0 4.9 neutrophils 12.85 calcium normal renal function normal electrolytes normal lfts normal mlas normal crp 1 urea 15 from previous baseline of 3.8 venous blood gas lactate 1.4 inr 1.4 note recent ultrasound abdomen december 2025 for episodic but recurrent abdominal pain triple a 5.9 centimeters metabolic dysfunction associated steatorrhotic liver disease bladder diverticulae medications list epimax cream only past medical history alzheimer's disease with early onset housebound aggressive behavior with wife who is his carer orthostatic hypotension 2021 umbilical hernia repair 2014 tonsillectomy and adenoidectomy 2014 has recently been using nsaids barry is awaiting the results of his ct scan over recent days appeared unwell lightheaded vacant when standing yesterday passed an entirely large liquid dark red bowel motion while standing he became pale clammy and nearly fainted he's been prescribed naproxen and codeine for back pain has been awaiting a ct scan but it doesn't appear that it's happened hi barry is it barry hughes hi I'm rob I'm 1 of the doctors it's nice to meet you oh good good good sorry to make you laugh aw who are you are you missus hughes oh they've got you in bed how nice well I I I did have lot you were another patient I felt bad about waking you up I didn't feel bad though so that's good nice to meet you lovely to I'm you rob I'm 1 of the gastroenterology registrars yes I happen to be the medical registrar on call today good day sir I'm sorry to hear that you're bleeding I'm bleeding yes it seems like it no I'm not alright fine the a and e team told me there was lots of jet black stuff coming out oh I don't know no fine no nothing like that good that's fine then yeah you're looking quite pale I must say are you feeling alright chest injury have you got any pain in your chest no sir shortness of breath no sir good man alright then that's fine I think I really enjoy life good evening to your chest do what you need thank you so much some normal heart sounds do some big breaths for me and up and again yep yep that's that's lovely your chest is nice and clear any pain in the tummy no sir good and can I have a look at your legs sir look so I've read a little bit from the care home over the last 2 days they've noticed some loose stools tinged with red and that they were black this morning is that is that right any any other gems no yeah well won't they asked him if he's perfect but I wonder the nurses and that about getting him up but then this here this this little ex fluid here mhmm because he hasn't been able to squeeze got quite acid reflux and mhmm barry is the main thing use food no but he's good yes mhmm yeah and he hasn't he's not able to eat the of course the stomach can't really help goes I mean they said I had to get all new cloves it it's it was 40 pounds but 10 inches went on around the waist they said he's been having some back pain recently yeah and then started some naproxen I understand yeah and that was a couple of weeks ago is that fair to say well no it it it's now as well because he actually when they use the the plastic thing or whatever yeah he he actually school which I've never heard of doing it just doesn't do that we'll try and get you all time like I really feel for your doctors because like when anybody alright when you know he says oh perfect mhmm and he's not hurting but then he he really screamed when yeah yeah when he's moved yeah he's got an appointment what is that it's actually yeah for a ct scan is it no no with the vascular surgeon okay at his triple a yeah right it's vessel at the time yeah they might come and see him on the ward but they might not okay so we forget that they might come they'll still be on their list and they might come to see him where he is they'll know where he is they'll know he's in hospital really so they may have time to come and see him yeah but it's it may also be just that we reschedule okay alright so but what he's got now mhmm that doctor explained to me it's different issues to the aaa exactly they're very different to the aaa correct yeah yeah it seems as though from looking at the blood tests you've become quite anemic the blood counts have dropped never seen the difference for me yeah well there and the marker in the in the blood of digesting blood has gone up so it looks as though you're bleeding and then redigesting the blood alright and that what I suggest is probably from an ulcer in the stomach or the tb and probably because of nephrostomy we know it can irritate the stomach or the first part the small intestine that can happen and lead to ulcerations as well mhmm and that can bleed and that seems to be what's happened so what should we with what so we give you some we make sure you've got some good access in so some nice big canvas so we can give you some blood if we need to all right we give you a drip of some anti acid medicine omeprazole which you probably had before very strong omeprazole through a drip all right and then I'll refer you to see 1 of my consultants during the day to have a camera test alright if that's alright yeah we'll use a long flexible camera over the back of your tongue alright and your oesophagus into your stomach we find the ulcer and then we fix it you're on we'll put some clips or some bands and we'll inject it and we'll get okay sound alright yes good yeah he's he's gay I am 2 minutes later we make you quite sleepy for the test so he doesn't we won't remember thank you thank you yeah I'll swap that I'll put 1 at them or a couple of others thank you it's alright so is he being admitted to somewhere yeah think you need to stay in hospital come over to our acute medical unit and then from there go on to our gastroenterology ward alright do you take any blood thinners no I think you did up until this aa I've not been on any whatsoever the efforts cream wasn't it was it yeah but I mean you know it was a whole life and then the a a a you've not started any tablets for the a a a have you no no should use tablets there's nothing on the gp at work in this doctor no just to see the can I touch your tummy and feel your your triple a need little 936 yeah bit thank you but well that's 1 way to look at it another way to look at it would be if you haven't had the ultrasound scan for tummy pain and you've never known about it a lot of those incidental things that we see that may have caused him no trouble at all do you know what I mean yes it's very difficult to know what will happen with these things the natural history of them is that they do gradually enlarge the ones we're watching and sometimes they need operations to fix them but there are lots out there probably that we don't know about okay so I think it's something to get sorted out not I yet but I was sort of thinking it was the end oh goodness yeah it certainly isn't it's reasonable sized I guess there's lots of things we can do with medicine I think we can make you better the question I guess is should we make you better is the life you live at the moment 1 that you like to return to yes in the care yes yeah I think that's a difficult 1 isn't it yeah yeah what do you think echocardiogram no it's really hot it's not going oh takotsu there's cardiac effects really yeah there's no growth in it I've I've had a lot of trust sheets my person who's diagnosed too he got a good on your transplant were you scheduled a dialysis or perfect batch to give him my I mean he was in a situation I've given him my kidney now I've lost all the tests and nothing happened so my I campaigned so much and prior to that I worked in well worked in hotels and fjallions but laterally I was doing pr my son said there was no way you'll get them in touch with me during this event and not doing any of paper because I couldn't get enough to run they wouldn't take my kidney yeah but I've done it now then they put me in a room and said you're not allowed to give me kidney because your son's family's brain injured and you're not allowed to and I said I'm doing it yeah so like then wrote in those papers he in the jail at hotspur somewhere ever came out but they discovered he'd also got really sticky for this was really like something more strange and okay in school like we work for my friends you know he was going places so I've lost but school it's like no no I mean and people go away from you and all these friends have you know moved on they've all over the world his friends from school he kind of he couldn't see or hear anything he was 3 weeks in intensive care at school so because he was on dialysis so I this on top too much to bear yeah I've had a lot of operations myself like from bed yeah and he lives in the care room yeah is that right yeah which is fantastic hold the rise it's not that's in your ear at all it's me more than we can see not to me yeah yeah do are you with me I understand yeah yeah is it what he was born oh god no because obviously you know had a bit of a role sure well it's not being together 15 years it's not you know a well spot of his life but I mean he had a very successful career almost a charmed because yeah where was it you you worked in america ghana yeah and where else denver yeah he did buying for this company called something sykes that and he was cheap buying mhmm so he could it was like argos okay or amazon right he traveled to go and see things and he got this huge expokes of karen and these people that were being reliable it's it's a lot I find it well that's why I think it I've got what they call it stress disorder complex is memory goes and you can't shake yeah so it and is would you lie down yeah anyway it's cruel I'll try and sit you up his 3 children did not believe that there was anything wrong with him no well they said it was hate because he can mask at home well they they have snapshots of what you desire and so it's not like never with something yeah and holding up a blackboard you know this is the that's it sort of what you're asking mhmm yeah so no I don't it's not there we go what you wouldn't want to have been there you may but they are fabulous I don't know how you in as medicare you know people say how are you today is this unperfect for school just go in life yeah it seems happy doesn't it I enjoy life I enjoy life yeah we moved down here because I thought we used to go to greece things like that and I thought if we at least with the other sea I find funny yeah calming yeah you know works are shuffling and can't be in a new place yeah yeah you got yeah well he was doing that a lot before but you you can't I think it I copy now no it it's you create a challenge it's so cool watching someone out of breaths mhmm yeah with the kids you always watch them get better and better and that's probably okay yeah having it twice was yeah but I mean stop must yeah because he's very he's got damage to the parathyroid because he had a big seizure in the hospital and so he still got that rocking ball but and he learned to he learned to everything again but he has got short term memory loss but he can remember how he was he can remember danny what right he wanted to go in the mountain police he can't ride that and he falls off mhmm yeah yeah so it's like he can mask it with some but with me yeah it's yeah I don't how charge it's yeah it's the brain got me fixed really isn't it so so I've been walking yeah I've only come to school last month well loads of stuff I mean you can this is maybe better that's it yeah and it and it's getting more isn't it and and it wasn't on any tablets whatsoever before birth mhmm so think that given it's our fault given that we gave you the naproxen it seems a shame to not fix the problem that we've caused right do you know what saying yeah it's our fault you've got this ulcer us doctors honey you wouldn't have got this ulcer by yourself and gave you the naproxen or gave you the ulcer for your back and that's why his back's hurting well yeah mean your back might be hurting for a lot of reasons but certainly the the toxin that we gave you hasn't it may have helped your back but it certainly will help your tummy bleeding from the tummy is from is from that right back I think you're have a ct scan in your back where you do have the scan can't see a report but it might be that you had it in the next week yeah you had it yeah and it's sunday there may well be some osteoarthritis changes in his back you can see the report when it comes back in the next few days they've said they put through the doctor I saw at the home said they put an urgent request to have it done quickly so that the vascular surgeon could look at it mhmm what what happened today the the pictures will be there so well they showing you the pictures yeah so there's couple pictures so should I stay I thought I'd just stay here because I've got the 2 for myself yeah no that's really helpful it's nice to to talk to you about that so thank yeah no it's by we'll come back with a consent form for the camera test is that okay yeah yeah yeah yeah yeah yeah yeah I'll give you a drip of some anti acid medicine quite a bit I'll give you some different painkillers thank you that I wouldn't be able to paint that with okay yeah I mean I've I've just been so you know was I was really confused because you know the gp said right come here we were an hour in 1 ambulance the only thing that's coming up quickly yeah and then an hour in another ambulance because we couldn't come in mhmm and then we got here and it's like dense yeah yeah and oh we're just waiting for the doctor and I thought you know it's I think the ailey doctor would see you and see if he's awake your blood really right no think it first drop stop yeah it's what should you do then you know just feeling that I couldn't go of course yeah without can't talk to myself feel no no no yeah yeah so I just don't know what to do now I don't know whether to go or it's completely up to you we're more than happy to have you here and host you as best we can but we'll also look after him so now he's seeing you you we'll see it will be I don't have a magic bed unfortunately so you were always waiting for the bed to come over to my acute medical unit but you send everyone over my acute medical unit now so you've come to a and e you start seeing people a bit more yeah because that's what the gp insisted on they they said that was what was going to happen mhmm and and I understand that you're kind of you know you're I'm not good around yeah and I'm just not I mean no and you're either you know I was born with esmer and esmer and I was in hospital so I had school in hospital in ireland and I'm just you know it's not good for me yeah it's okay it's you know because like you you know got a gift that you're clever enough to I could never have been when I saw anything being around people's wedding they have to pay me to come here do they oh well that's a lot that's alright yeah yeah they pay you it's okay you just went to university for a few years I did it's a bit of a brain yeah yeah oh dear but yeah so we yeah as I say we'll be more than happy to look after him we he'll be here when we look after him don't you want to go home and get some sleep that's absolutely fine yeah it's for him to look after him but so so now that you've seen that it's all on his nose yeah and materially nothing changes I've seen him which is lovely very good nice to meet you I'll I can get some things sorted for you in the way of having a test which we can do at some? Tomorrow the camera test as well as the drip for the antacid medicine till then but in terms of practical things you'll still stay here until there's a bed on the uk medical unit there I mean you're not a magician you can't say no our hospital is full and we're waiting for discharge to the from the wards you must look into an article I think it's you guys that really suffer that we just traipse through as always it's the people that you have suffered across the hospital overcrowding it doesn't matter to me I don't mind seeing you here seeing you there seeing you all across the country but you're the 1 that has to stay on the trolley crowd so I'm sorry thank you this is quite lush yeah it's luxurious isn't it very comfortable yay just I don't know so are you it's good she hasn't mowed with me fair enough my friend stayed over christmas I got a friend there I worked at the university I worked lecturing and there was the thing on for at big child places you know so he says you know my friend was sitting opposite and he said we've gotta get 1 she said what's happening and he said what are card do you get she said what are you going to get that tesco express tesco express quite high and you get the points as well there you go very good very good think signed on impression upper gi bleed secondary to peptic ulceration secondary to naproxen secondary to back pain awaiting ct scan scan to further investigate plan stop naproxen number 2 start ppi iv number next inpatient endoscopy consent form 4 completed number next allerton ward