Authors: Laura Beard, Adam Brown / Editor: Jason Kendall / Reviewer: Caitriona Considine, Misbah Mohammad / Codes: A3, R2 / Published: 19/09/2022
A 41-year-old gentleman presented to the Emergency Department (ED) with a three day history of vomiting blood and the passage of bright red blood rectally. He complained of moderate epigastric pain and had called 999 after collapsing whilst on the toilet. He refused to come to hospital two days earlier when seen by his GP.
He had been taking ibuprofen regularly for three years due to chronic back pain and had recently started taking diclofenac. He was also on medication for ulcerative colitis.
On admission to hospital his observations were as follows:
Temperature 36oC, HR 125, BP 160/70, RR 16, Oxygen saturations on pulse oximetry 100%.
He looked pale and unwell. Abdominal examination revealed epigastric tenderness with no guarding or rigidity and there was bright red blood on rectal examination.
Further investigations were as follows:
- Arterial blood gas analysis: pH = 7.51, Lactate = 6.1mmol/l, Hb = 8.5g/dl
- Haematology: Hb = 8.7g/dl, WBC = 33.5, Neutrophils = 34.4 PT = 12, APTT = 34.4
- Biochemistry: Urea = 6.9mmol/l, Creatinine = 93 mol/l
