 64/C/M presented to the A&E with c/o
SOBOE, giddiness and lethargy.
 He gives a history of passing out black tarry stools yesterday.
 He has been taking diclofenac sodium regularly due to bilateral knee pains.
 He has also drinking alcohol regularly, i.e. 2 large bottle of beers daily.

 How important are the colour of his stools?

 What are the possible causes of his GI bleed?

 What other physical signs are helpful to determine the cause of GI bleed?

 The patient was found to be drowsy, with
M5V3E3 (GCS 11/15)
 BP was 95/70 mm Hg
 HR 110 bpm
 Peripheries was cold and clammy
 Pulse was feeble
 SpO2 95%

 What is the causes of the low GCS?
 What is the significance of the vital signs recorded?

 You find that he has 8 spider naevis, absence of axillary hair and gross ascites.
 He has a flapping tremor.
 He also has multiple bruising over the extensor surfaces of his arms.

 What could be the other cause of his low
GCS?
 State the stages of hepatic encephalopathy.



Suddenly, he develops haemataemesis.
Do you insert a Ryle’s tube? State your reasons for doing so.

 You check the vital signs again :
– BP 84/50 mm Hg
–
–
HR 150 bpm
GCS M3V2E1 (6/15)
– SpO2 89%

 Why has the vital signs worsened?
 Why has he become more hypoxic?

 What do you do now?
 List down your approach to stabilizing this patient.

 TWC 13.5
 Hb 6.0
 MCV 80
 MCH 30
 Plt 500
 Explain the results above.
 Would you expect hypochromic microcytic anemia?

 APTT 40
 PT 15
 INR 1.8
 What are the possible causes?

 What other tests to order to elucidate the cause?

 Urea 28
 Creat 140
 Na 130
 K 3.7
 Explain the results above.

 TP 60, alb 23
 ALT 878
 ALP 30
 Explain the results.

 RBS 3.0
 Why?

 What blood products do you want to give and why?
 What is the target Hb in this patient?

 List all the problems / diagnosis of this patient.

 What is the definitive treatment of this patient?
 Are there any drugs which helps reduce bleeding?

 Are antibiotics needed in this patient?

 What is the follow up care for this patient?

 60 year old man presents with 1 week history of malaena and shortness of breath?
 On examination he his pale and cachexic.
 Hb 9.0g/dL MCV 60 MCH28
 PR showed malaena, examination of the abdomen was unremarkable.
 BP 120/80 mm Hg
 HR 99 bpm

 What could be the possible causes of his
UGIB?
 What investigations would you send?

 Would you transfuse him with blood?
 What are the indications for blood transfusion?
 How fast would you transfuse the blood?
 Do you need to give IV Frusemide as well?

 OGDS showed a Forrest IIc ulcer.
 What does this mean?

 How can the ulcer be treated endoscopically?
 What drugs should the patient be given?

 Patient asks you what are the risks for
OGDS. What do you say?