Gastroenterology MCQ 134

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Peptic ulcer diseaseA 50-year-old man presents with hematemesis and hematochezia. One-week prior he began taking ibuprofen for tennis elbow. Physical examination revealed a blood pressure of 80/60 mmHg and a heart rate of 120bpm. Bleeding ceased and resuscitation was successful in normalizing his homodynamic instability. Because of the NSAID use, his physician suspected an ulcer and requested an urgent EGD that disclosed an isolated clot on the incisura that was easily washed off to reveal a 1.5 cm ulcer with a non-bleeding visible vessel. The lesion was injected with 5 cc of 1:10,000 epinephrine leading to blanching of the ulcer base without hemorrhage. Rapid urease testing was positive for H. pylori infection. Intravenous pantoprazole (40 mg IV Q8H) was ordered to begin immediately after the endoscopy and the patient was observed closely in the medical intensive care unit. However, 10 hours later the patient developed massive, recurrent hematemesis.

The next step in management is:
  1. Urgent surgery
  2. Angiography
  3. High dose intravenous PPI therapy
  4. Barium upper GI series
  5. Repeat EGD
Answer

Category: Gastroenterology MCQs

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