Beth is a 65-year-old regular practice patient who has arranged a same-day telephone consultation with her GP.

Beth reports that 36 hours previously she woke in the middle of the night with severe epigastric pain with associated nausea and diarrhoea.

She recalled eating a rich (and perhaps not so fresh) cake, a few hours earlier. Her husband, Jim, ate the same cake but has been well.

Beth took some paracetamol with warm tea that night and felt some improvement.