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Old 06-04-2012
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GIT UGI bleeding with falling Hb !!

A 42-year-old man is hospitalized because of hematemesis and melena. The patient takes ibuprofen for management of arthritis. He is otherwise healthy and takes no other medications. The patient is hypotensive on admission, and intravenous fluids are begun. No blood transfusions are needed. Upper endoscopy shows a bleeding duodenal ulcer that is treated with injectable epinephrine and clipping. Biopsy specimens for Helicobacter pylori are negative. Ibuprofen is discontinued, and a proton pump inhibitor is begun.

On hospital day 3, review of the patient's laboratory studies shows a hemoglobin level of 13.5 g/dL on admission, 12.7 g/dL on day 2, and 11.4 g/dL on day 3. He has not had recurrent hematemesis, melena, dizziness, pain, nausea, or orthostatic hypotension. His last bowel movement, 24 hours ago, was a formed, normal-appearing stool.

Which of the following is the most appropriate next step in managing this patient?

A Blood transfusion
B Colonoscopy
C Fecal occult blood testing
D Repeat upper endoscopy
E Hospital discharge with outpatient follow-up
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Old 06-04-2012
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E Hospital discharge with outpatient follow-up.
this fast drop in Hb is best explained by fluid replacement to replace lost blood vol.
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Old 06-04-2012
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E Hospital discharge with outpatient follow-up
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