|Think MI = EKG, CE|
|Most Common Cause = Non-ulcer Dyspepsia|
|What to do? →||Endoscopy if →||> 45 y|
< 45 y + Alarm Symptoms:
- Blood in stool (Anemia)
- Weight loss
- Early Satiety.
ITE 2013, Q#108.
A 57-year-old male comes to the emergency department after several episodes of vomiting preceded by moderately severe epigastric pain. He says the vomitus looked like coffee grounds. He tells you he has had “heartburn” in the past that was sometimes severe, and occasionally associated with vomiting, but these episodes were almost always relieved by oral antacids. This problem was exacerbated recently after he began taking ketorolac for moderate arthritic pain in his knees and hands. His past medical history and a review of systems reveal no major comorbid disorders.
The patient’s blood pressure is 125/82 mm Hg and his heart rate is 95 beats/min with no signs of shock. His hemoglobin level is 9.5 g/dL (N 13.0–18.0). He is admitted to the hospital and placed on a proton pump inhibitor (PPI) infusion. Upper gastrointestinal endoscopy performed within 3 hours of admission shows no blood in the upper gastrointestinal tract, but reveals a Mallory-Weiss tear and a stomach ulcer containing a dark spot in an otherwise clear base.
Management at this time should include which one of the following?
A) Transfusion with whole blood
B) Repeat endoscopy within 24 hours
D) Continued in-hospital observation for at least 72 hours
E) Discharge from the hospital on oral PPI therapy