Clinical case 1

You are reviewing a 70-year-old man with a two day history of epigastric pain and melaena. He has a past medical history of hypertension and TIAs. He takes clopidogrel.

On examination he has a blood pressure of 90/60mmHg, a heart rate of 140bpm, and he looks  pale. He has epigastric tenderness and melaena on digital rectal examination.