Bit of a disc or a bit I don't know I was laying on the sofa for a while and now I went to isoproam and I just finished the phone call I don't really remember anything else you know it was perhaps I was out I'm on the screen and sparked out I think but then I suddenly looked down and thought what's happened thought thought it was like red blueberries or whatever jamie has a photo in the mountains I didn't well yes it shocked me how does that work so I I couldn't change 1 forever yeah it's a fair amount definitely glad isn't it it was wonderful sorry about the state of the curve yeah thought I'd be all that nature you really are inconsiderate yeah so you don't get heartburn no do you drink alcohol yeah well over the weekend I get heartburn watery yeah yeah couple of glasses of wine yeah bottles of wine yeah kind of thing over the weekend yeah yeah anything in the week no no no at no no no no nothing no nothing that's fine and what do you do for anything I work for a dairy company it's a sort of of trading milk and milk products spontaneously sort of thing fine and exporting so office kind of work yeah yeah all all home based home based office gosh fine alright and take any regular medicines nope no you look fit and healthy you look like you exercise a bit is that what you say yeah I would I I don't walk into my things so mhmm I mean I've got too many step things so I I do probably about 25,000 steps a day mainly a bit over a year fine so how many dogs do you have only a couple mhmm only a couple but yeah so you know I try try and no no you're starting to help yeah we only have class can't do class but then we need class yeah would say very classy very hard to keep positive health seem likely yeah fine this is all a bit strange isn't it yeah so you don't get heartburn no not a thing for you never had it no do you have a big cowering no never never you go lie down in bed at night and you go oh not the thing for you no no no sometimes people just have it and don't say it that's sometimes when you eat late isn't it yeah so that's not really your thing no no no and how's your weight been recently is it good good I weighed myself the other day and I was just what did say was like 12 stone 1 yeah you're losing weight hot the ones around 12 stone yeah if it's 800 yeah and how are your bowels yeah okay brown that measure yeah brown both jet black no no not brown not black not black brown yeah and when did you last get your pee to get the late this morning this morning okay very good and over the thinking over the days leading up to this have you been feeling well yeah yeah no I haven't had any issues at all no I mean as I said had of late is had a bit of a backache that hasn't really all it is to chiropractic careers and that yeah so it's but that hasn't that's probably the only thing and you have been a little bit kind of holding yourself because of backache but mhmm you've had that for some time and normally normally goes you go to chiropractor chiropractor and everything what 3 or 4 months 3 months every 3 months but you've had 2 sessions lately and still not a 100% mhmm it felt like there was something whereabouts in your back is sore because there was just a little. That just lower back don't take any regular medicines I understand no no alright any health problems in the past at all no no okay is it okay no feel any other concerns and your heart's up it's a good feeling okay it's it's nicely clear your blood pressure is 5 it's about a 170 or 75 it's lovely and your heart's not going too fast or anything which is good give me a nice soft tongue tummy yes lovely fine so it's a bit performative examining you you're expecting to find anything we we know what's going on you're you're bleeding from inside probably in your esophagus that's where you most if if it got into your stomach you'd probably go down the other way and come out with jet black tarry stool right you might have some jet black tarry stool over the next day or so because looking at your blood tests you certainly have some of the markers on the blood test of digesting blood so it seems as though you're absorbing a lot of protein probably from the blood you're digesting so you may have bled a little bit and it's gone down then a little bit more and it's come up blood is very irritant to the stomach so it doesn't like it in there often people will vomit back but it certainly looks very fresh it looks like it's come from your esophagus to me which is the gullet the tube that connects the back of your throat to your stomach which lives about here its whole job is just to move food through but sometimes acid can wash up over the lower gullet sometimes people don't realize it it can erode the wall of the esophagus a bit it can bleed yeah sometimes you can have ulcers in your stomach or your small intestine that bleed and cause these kind of symptoms exactly I understand you don't take any ibuprofen or anything like that is that fair to I would take them if I got a headache yeah so I I don't take them mean the only thing I was saying is when I went to the chiropractor the first couple of times he said you can you can blitz it with a couple of ibuprofen and a couple of paracetamol do that twice a day in which I did yeah but I haven't really taken it but you're not a big lover medicine through a drip calms down the acid production in the stomach and stops any more acid eroding at whatever's bleeding and I suggest we do a camera test to look down to see what's bleeding and see if we can fix it yeah yeah is that okay yeah we can do that as an inpatient we do it tomorrow we know we I could have got you sorted to do it this evening but the evidence shows that waiting a bit more having a bit more resuscitation and a bit more anti acid medicine has a better outcome than doing it early and rushing it so it's best to get you optimised as possible for that test where we can have a good careful look find out what's going on if needed we can treat that over time so we can use bands and clips and burn things away with our camera we've got lots of fancy tools we can use to stop it an upper gi endoscopy you had 1 before I've done 1 but the other end oh fine yeah it's a lot shorter than a colonoscopy and you don't have to have the prep obviously yeah but the prep is not is you not eating yeah so which is why we've starved you sometimes eating itself can trigger more little bits of bleeding so that's kind of part of why we starve you and also be good to make sure that if you do have a big bleed at 03:00 in the morning you're here in hospital and we can do it right then and there if needed but it'll be difficult to do if you've just had a massive meal so we'd suggest not eating anything until we do the test right right alright what time will that be tomorrow then probably do a lunchtime tomorrow right yes okay that's it long as you've gone away from I wouldn't say have any dinner or breakfast just in case in 03:00 in the morning you bleed then you you got a a clear tummy that we can go in and fix whereas if we go in and try and suck up a plate of potato it's okay to drink anything or you can have sips of water yeah up until a few hours before the test so you can have sips of water throughout the night that's absolutely fine but yeah about 4 hours before the test stop drinking the water and then we'd have a good look at that is that alright yeah yeah cool okay so he'll be admitted tonight he'll stay in hospital tonight he'll come to our acute medical unit and we'll do the test tomorrow yeah any questions anything I've forgotten no no makes sense I should always I talk to everyone who comes to hospital about resuscitation I think if something were to happen we should do everything to keep you going is that fair to say that's fine sometimes people have strong views about it and I have to discuss it with you because I put a form on the computer to say that's what we like okay yeah no completely well well I'm trying get hasty now mister inheritance that's not not bad I'm just gonna tell you I like being here good god no no we're gonna go to the doctor to keep that being here you're just here because you're in our high intensity area it's the best place to be at the moment because you've got the best nurse in hospital looking after you like they're keeping a really close eye on you which is good but after a few hours you've been here a bit you haven't had any more bleeding it's all quite reassuring your numbers are fine your blood tests show your blood counts haven't dropped significantly which is good all those things reassuring will get you over to where you keep it but you don't know how to see it okay perfect lovely alright and will I be able to have him as well this morning when I'm not you're welcome nothing okay it's all individual bed spaces similar to this and I keep medical no I've definitely been so yeah alright nothing yeah are you in any pain at all sorry you're in any pains no no no no no I'm doing you don't have pee at some. If I'm gonna do that too it's fine I you wouldn't recommend going to the toilet we could bring it coil it to you like a conveyor or something like that or you can give me a bottle if you don't want to go cold so on examination heart sounds normal respiratory chest clear abdomen soft and untended no peripheral edema some evidence of blood staining around the mouth and photo seen of blood on the floor of the living room definitely fresh red blood very convincing for gi bleeding the impression is upper gi bleed possibly silent reflux leading to esophagitis but multiple underlying causes are possible plan admit to acute medical unit + or - allerton ward number 2 ogd aimed tomorrow at the lunchtime bleed slot number 3 iv ppi until ogd thank you yeah yeah much better thank you 4 tap full escalation number 5 can step down from recess number 6 if further hematemesis or evidence of hemodynamic compromise then full discussion with on call endoscopist to consider out of our scope