WHAT INVESTIGATION WOULD YOU CARRY OUT FOR A 42 YEAR OLD MAN PRESENTING WITH A 1 DAY HISTORY OF VOMITING FRESH BLOOD AND PASSING OF BLACK COLORED STOOL FOR AT LEAST 3 DAYS?

A 42 year old man presents to Accident and Emergency Department with a 1 day history of vomiting fresh blood. He also reports the passing of black coloured stool for at least 3 days and feeling generally unwell for almost 6 weeks. his main complaints is of easy fatigue and he’s unable to carry on his work beyond 3pm . he is privately employed as a driver and does not fit drink alcohol. his past medical history is uneventful with the exception that he had 3 episodes of jaundice:first when he was 20years old, then 4-5 years after that and a further episode about 3 years ago. Each time he was seen by a herbal practitioner who prescribed some herbs, and after a few days the patient felt better. The main reason for not seeking medical attention was financial constraints as he thought a doctor would order lots of test that he could not afford

a) what would  your differential diagnosis include before examination..

b) what investigation would you carry out

 

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