A 78-year-old man presented in the OPD with a one-day history of coffee-ground vomiting and black, tarry stools. His medical history is significant for hypertension and osteoarthritis. He regularly takes diclofenac 50 mg three times a day to control his knee pain, as well as aspirin 75 mg and bendroflumethiazide 2.5 mg once daily. Physical examination The patient felt cool up to the wrists and his pulse volume was reduced. His jugular venous pulse (JVP) was not raised. Respiratory and abdominal examinations were unremarkable.
Per rectal examination confirmed fresh melena. The patient’s hemoglobin level on admission was 8.2 g/dL (normal range 13–17 g/dL). An oesophagoduodenoscopy (OGD) was performed which showed a large duodenal ulcer with surrounding areas of bleeding. It was injected with adrenaline. He has been treated with intravenous proton pump inhibitors to aid ulcer healing. Twelve…
