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  #1  
Old 05-31-2012
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GIT Management of Upper GI Bleeding

A 68-year-old man is evaluated in the emergency department for a 6-hour history of nausea and vomiting with some bright-red emesis. For the past 2 hours he has felt lightheaded and weak. On physical examination, temperature is 37.0C (98.6F), blood pressure is 88/51 mm Hg, pulse rate is 114/min, and respiration rate is 18/min. Nasogastric aspiration shows a mixture of coffee grounds and dark blood. The abdomen is not tender, and bowel sounds are normal. Laboratory studies reveal a hemoglobin level of 9.4g/dL (94 g/L); all other tests are normal. Intravenous omeprazole therapy is begun, and the patient is stabilized with infusion of normal saline and transfusion of two units of packed erythrocytes.

Which of the following is the best management option for this patient?

(A) Esophagogastroduodenoscopy
(B) Immediate surgical intervention
(C) Observation
(D) Octreotide infusion
(E) Ranitidine infusion
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Old 05-31-2012
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- (A).CUZ wecan see the source of bleeding ,and inj rx or apply band or cauterization.
-opt B. since pt stapliz no need.
-optC.pt has active bleeding ,so it abad option.
-d. can be but endoscopy is superior.
-E. PT ALRADY PUTon omeprazol.
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Old 05-31-2012
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I would go with C , it's most probably due to vomiting cause the rest of examinations are normal and also he is stabilized now
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Old 05-31-2012
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Quote:
Originally Posted by um aala View Post
- (A).CUZ wecan see the source of bleeding ,and inj rx or apply band or cauterization.
-opt B. since pt stapliz no need.
-optC.pt has active bleeding ,so it abad option.
-d. can be but endoscopy is superior.
-E. PT ALRADY PUTon omeprazol.
agree except for D octeriotide is only used in case where bleeding is from varices which not the case here (no clue to liver dz & labs are nl)
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Old 05-31-2012
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Which of the following is the best management option for this patient?
(A) Esophagogastroduodenoscopy
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Old 05-31-2012
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Originally Posted by Aajj View Post
I would go with C , it's most probably due to vomiting cause the rest of examinations are normal and also he is stabilized now
You don't want to find out what caused the bleeding severe enough to cause hypotension and a significant drop in Hb in a 68 yr old?
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Old 05-31-2012
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Originally Posted by Novobiocin View Post
You don't want to find out what caused the bleeding severe enough to cause hypotension and a significant drop in Hb in a 68 yr old?
also endoscopy helps to nail down the diagnoses , and can be therapeutic. it can also tell who is more at likely to further bleed [ ulcer with visible clot or ulcer with visible vessel]


that means any patient with UGI bleed need a UGI scope . right?
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Old 06-01-2012
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If its a Mallory Weiss Tear ( as it looks in this question ) conservative treatment is the choice, but on the other hand the question also says sth about dark brown blood which needs endo . Kinda dumb question
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Old 06-01-2012
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Originally Posted by Aajj View Post
If its a Mallory Weiss Tear ( as it looks in this question ) conservative treatment is the choice, but on the other hand the question also says sth about dark brown blood which needs endo . Kinda dumb question
I didn't see the words "alcoholic" and "retching" in the question.
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Old 06-02-2012
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@Tyagee hey can u plz post the answer to this Q and also what's the source of these questions? Thanks
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  #11  
Old 06-02-2012
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Originally Posted by tyagee View Post
A 68-year-old man is evaluated in the emergency department for a 6-hour history of nausea and vomiting with some bright-red emesis. For the past 2 hours he has felt lightheaded and weak. On physical examination, temperature is 37.0C (98.6F), blood pressure is 88/51 mm Hg, pulse rate is 114/min, and respiration rate is 18/min. Nasogastric aspiration shows a mixture of coffee grounds and dark blood. The abdomen is not tender, and bowel sounds are normal. Laboratory studies reveal a hemoglobin level of 9.4g/dL (94 g/L); all other tests are normal. Intravenous omeprazole therapy is begun, and the patient is stabilized with infusion of normal saline and transfusion of two units of packed erythrocytes.

Which of the following is the best management option for this patient?

(A) Esophagogastroduodenoscopy
(B) Immediate surgical intervention
(C) Observation
(D) Octreotide infusion
(E) Ranitidine infusion
ans is A. why? because it helps to know the cause of this massive bleed.
reg source of q, i can pm you if u want.

Last edited by tyagee; 06-02-2012 at 12:44 PM.
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