10.45am Gail Parsons – Heartburn

Gail, a 35-year-old lady, presents with right upper quadrant pain which scores 9/10. She has had a dull pain for the last 4 weeks but today has worsened.

No diarrhoea or vomiting. No urinary symptoms.

Slight fever 37.8, pulse 66 regular, sats 99% in air, rr-20. She claims it is worse after omelettes and cheese toasties.

She has had acid reflux for the last 9 years which she is taking Omeprazole 20mgs once daily. She has a BMI of 35 with no other past medical history.

She used to be a heavy drinker drinking over 30 units of spirits per week for 15 years. She smokes 10 cigarettes a day.

She has no shortness of breath or chest pain.

She has been taking Naproxen 500mgs twice a day for the pain which she had from her husband who has gout.