Elderly man, critically unwell.

1. Severe anaemia with significantly elevated Urea (with features in stem) suggest severe life threatening upper GI bleed requiring resuscitation and early referral to gastroenterology.

Elevated ALP and GGT together with low albumin and total protein suggest chronic alcohol abuse.

Normal ALT may indicate chronic liver disease and cirrhosis (although Bilirubin normal)

high WCC – stress response

2. Oesophageal varices

Duodenal Ulcers

Gastric erosions

Gastric Ulcers

Mallory Weiss tears

3. Glassgow Blatchford score

4. Age

Male sex

SBP < 100 mmHg

HR > 100/min

Urea > 6.5

Malaena

syncope

??history of liver disease

(no cardiac history given)