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Hematemesis - Differential diagnosis includes gastric ulcer, gastritis, esophagitis, and Mallory-Weiss tear. Risks/benefits of EGD discussed with patient including bleeding, infection, perforation, and death. Patient agreeable to proceed with upper endoscopy. See Post
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Melena - Differential diagnosis includes peptic ulcer. Risks/benefits of EGD discussed with patient including bleeding, infection, perforation, and death. Patient agreeable to proceed with upper endoscopy. See Post
Await pathology results. The patient should be on Pantoprazole 40 mg p.o. BID for six weeks on discharge. The patient needs to follow up with me  to discuss a repeat EGD in 6 weeks. Message was sent to clinic for follow up. Most likely source of bleeding was the gastric and duodenal ulcers. Avoid alcohol and NSAIDs. Differential diagnosis for gastric ulcer includes gastric cancer although less likely. Differential for gastritis includes H. Pylori infection See Post
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Blockchain for the US Dollar. Bitcoin and Litecoin work from an open source program. The cryptocurrencies can be considered a bubble with prices rising significantly in 2017. However, the technology can have other uses. Each wallet in the block chain network keeps a ledger of all the transactions performed. This ledger has already increased in size to 145 gigabytes for Bitcoin and about 11 gigabytes for Litecoin. Banks and individuals could use the block chain network to make payments with US dollars. There would be no currency created by mining but there could be transaction fees. Also there would not be a bubble in a limited currency which can be seen as a positive or negative. Currently each bank has their own system for sending money between their customers. This could be a decentralized system to send US dollars with lower transaction fees than current systems. â€ªAll bubbles are an immense transfer of wealth to early investorsâ€¬. See 1999. See Post
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