Gastroenterology MCQ 135

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Diagnosis and Management of Peptic Ulcer Disease (2nd Edition)A 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. Errors in this patient’s initial management include:

    1. Failure to treat the lesion with dual modality endoscopic therapy

    2. Failure to use a continuous infusion of IV PPI therapy

    3. Both of the above

    4. Neither of the above, re-bleeding occurs commonly in such patients even with appropriate therapy
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Category: Gastroenterology MCQs

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