Case 11


A 56-year-old gentleman is admitted for severe epigastric pain, tarry stools and generalised malaise. He has a past history of ischaemic heart disease, gout and recent biliary pancreatitis which he underwent endoscopic retrograde cholangiopancreatography for stone removal. He is a non-drinker and takes a COX-2 inhibitor for his joint pain.

Physical examination

Low-grade fever, pulse 100 bpm, BP 124/69mmHg, SaO2 97% on RA.

Hydration is satisfactory.

Examination of the hands reveals no clubbing and normal-appearing palmar creases.

Head and neck examination is unremarkable.

Cardiovascular: HS dual, no murmur.

His chest is clear on auscultation.

Abdominal examination reveals mild epigastric discomfort, with no definite mass.

Per rectal examination: old melaena.

No signs of oedema.



WBC 12.2 x 109/L;

haemoglobin 10.4g/dL dropped to 8.5g/dL;

platelets 259 x 109/L.

CXR: grossly clear, with no free gas under the diaphragm.

Urea normal.

Amylase 310 IU/L.

Liver and renal function tests are normal.

What is your differential diagnosis?

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Oct 23, 2019 | Posted by in GASTROENTEROLOGY | Comments Off on 11

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