I'm pretty clever that's clever yeah how's it going and rob we met before yeah 1 of the categories yeah vomiting up what's coming up well had a red frog coming up about 02:30 in the morning red there really so it came from up near this area you vomited out yeah it happened and I thought well alright alright and then we'll carry on we'll have there then it started being sick isn't it fresh red blood yeah goodness then basically goodness gracious very very very dizzy I couldn't walk anywhere I'll have to call you out again yes and here we are and here we are I thought he was aware of the clot I might do that I know about the clot I'm in in detail yeah I presume it's that I don't think so no I don't know what that is wee blood yeah it probably is blood I don't think it's coming from the liver I think it's you've probably bled inside in the esophagus some of us yeah you've had some treatment which is great yeah trying to shrink those down any black stuff at the bottom of it no not not rubbing and you've got a nasty cough it is a bit is that neem it's coming out of my abdomen here where I was still having trouble with my abdomen I know it's got the ascites that seems to have cleared up for a while that part this part not so your bladder or your hernia the bladder is hurting quite a lot when you pass water all the time so I'm mainly when I've caught the gi for you good had an absolutely terrible terrible thirst on me still have absolutely awful thirst that's been going on for the last 72 hours okay black stuff at the bottom end not that I'm aware of I haven't been today your heart's going a bit fast 130 degrees saturations are fine% respiratory's fine blood pressure's a little bit low 91 over 62 but you never have a fantastic blood pressure to be fair no haven't good can I have a quick look yeah sure sure you can we've had some treatment for you you need to look for this good you don't have to take anything off no you're still leaking off there or no no so you've got this large don't worry oh there right yeah soft you can get a sweaty sweaty please can I see your hands like you'd like to feel like this like you're stopping trafficking keep your wrists cocked back or something like that cool yeah alright do you lousy for a job 2 hours alright we'll see you for a 2 you so you're welcome great what is on the evening 12:10 10 alright yeah you've had a few blood tests to see what they show you've had some treatment for mogt which is great it's super aggressive I will get some fluid pouring in yeah you'll need some antibiotics going in yeah once we see the result of your tests we might be able give you a bit more supportive care the question will be whether whether we should go down with our camera and have a look and see where it's bleeding I'll check to my boss and see whether we can facilitate it was on the cars you didn't mention enough tyres in it actually it's likely on the cars yeah yeah what about being able to drink something I wouldn't recommend having anything right now water yeah nothing I'm sorry you can wet your mouth or something yeah that's fine you can just wet your mouth and spit it out we'll just have a tiny bit that's fine so investigations 116 from baseline of 85 sodium and potassium normal alp a 143 which is normal for the patient iverubine 17 from 8 amylase normal crp 7 previously 4 ast 54 inr 1.3 full blood count hemoglobin 93 from 105 on the february 17 venous blood gas ph 7.47 lactate 6.6 on examination abdomen soft and nontender flank bulging but no abdominal distension apart from large ventral hernia dressed but not currently leaking ascites right basal crepitations left clear heart cells normal unkempt hematemesis evident around the mouth smells of melena impression variceal bleed secondary to decompensated alcohol related liver disease decompensated with ascites aki bleeding but no current evidence of overt hepatic encephalopathy at the examination he's got no asterixis plan continue to elapressin iv fluid for aki and human albumin solution 3 units today 2 units today tazosin to continue chest x-ray given right basal changes query aspiration monitor inr and full blood count give vitamin k if inr greater than 1.4 recheck venous blood gas and full blood count as well as inr at 09:00 if hemoglobin dropping lactate rising or further episode of hematemesis following talopressin then for further discussion with the on call endoscopist discuss with on call endoscopist now happy with current plan but to be involved if further episode of hematemesis or changes above no clear role of ultrasound liver given very recent ultrasound showing stable appearances of nonocclusive portal vein thrombus add on ethanol levels to blood tests I'm eating this liquid I really need down there I know gagging for liquid and I know we've talked about a certain kind of liquid a few times with you haven't we about alcohol yeah I haven't touched it in over 2 years haven't touched it in over 2 years you're good no parker and I had a little blip for about 2 days once when was the blip for 2 days ages ago fine and no alcohol since no for how long now do you think you been complaining of way over 2 years probably yes including your blip when was the blip that was only for the days but was it in about 9 months no other blips in those 9 months for sure about that's fine cool great alright bro thank you let me come back with a consent form for the endoscopy care I need some liquid yeah you probably shouldn't drink anything but you can have something to wet your mouth as I said yeah I know but there's something cold yeah you can have something cold to wet your mouth that's fine I wouldn't recommend having something cold can I have the water please you've touched it I'm gonna ask you a question I'm gonna ask ask you that's you the question okay that's a question already may I ask you a question thanks thanks thanks john oh a nice pin yeah it's only but nothing but the best top of the range there's 1 repeat have you ever run out of pins or something I don't know somebody just wanted to make a a cardboard pin yeah like a recycling 1 you know it previously wasn't anything so somebody thought it's a shame you know chuck them on recycling or somebody so we wouldn't do all the super clinical waste but it's okay let me go to the exit so you can do the gas come on can do that I don't think we've done it can you feel the gas exchange again k can you feel any guts for you k we'll get the test call for the endoscopy and everything else tests so it's an upper gi endoscopy + or - treating the bleeding + or - putting a stent in the esophagus to tampon up blood vessels + or - going into your liver and unblocking that vessel that's blocked try and decrease the pressure yeah all right okay so you're in a you're you're poorly so it's this is all quite high risk stuff and you're doing our best to save your life so the benefits of diagnosing and treating your gastrointestinal bleeding the serious risks are causing more bleeding making a hole or a tear in the wrong place not managing to control the bleeding which we call failure there's risks associated with being put to sleep as problems with the breathing or the heart there's risks associated with not being able to bring you out of the anesthetic and sometimes rarely these procedures later can result in death but we're doing them to try and save your life I've signed it to say you'll either have a general anesthetic or you'll have some skin your signature is on the other side so if you have another episode of the vomiting I'll ask the anesthetic team to put you to sleep and we'll do it in theater alright if you don't have another episode of the vomiting we'll try and do it tomorrow and then go see okay yeah yes you you underdover then you ran your own mask alright I'll have to check see alright okay basically we get we've been doing after 10 minutes good until minutes now yeah maybe you want to what's your question so I've had this app in october 24 I've had mri ct ultrasound camera down the throat bloods ecg they all came back clear that's good but I've got the pain do you get the pain I never I never I never the time I never said constantly is it associated with any symptoms or allergy to tick no no apart from your right quadrant the whole time no and is it coming your way through when you crunch up your abdomen it crunch up your tummy and cut into a ball does that make yeah it I mean what's the plan are you seeing me back again I think so that would be after an appointment but you guys about everything with you and work out what's going on sometimes people get these syndromes that we don't work out and we can't find out anything on our tests but they usually respond well to different treatments that we've been trying to do for me so they tried me on nerve tablets amitriptyline yeah but they didn't what did they do they didn't do anything how much did you try quite a lot they gave me a box so I started off with 1 they said gpc I could increase it if I could get it yeah which I did and it's still in there yeah well said 10 of amitrex then you went up to 20 of amitrex right exactly yeah so if you have 30 to 2 bouts know just pain sorry pain or inflammatory isn't it you can we often use need higher doses than that we often put up 30 40 or a day sometimes you could try going up to 30 if it's effective sometimes we don't detect a cause sometimes there's things called functional dyspepsia and that's even very common in 70% of people have functional dyspepsia it can cause this upper abdominal disturbs but there are really wonderful things that can also cause it which can see even if you look at your blood tests does that try tramadol codeine codeine doesn't help it just pumps you up and makes it painless it's so painful be not constipated pain I'm dead I'm not eating all right mhmm no yeah I'm sorry I'm a painless shit isn't it no yeah we'll make sure we see you in clinic that'll be good yeah yeah I'm sorry I'm not gonna give you a call but it's unfortunate that you see it a lot yes yeah what do do here I'm a support worker mhmm I'm a worker I'm get around well well welcome back I have to give you guys a little bit of you a