Upper GI Bleeding
A 52-ycar-old man is admitted with .reports of a 7-hour history of nausea and vomiting with recent emesis of large amounts of"bloody secretions• and frequent •maroon-colored• stools. His mental status is alert but confused. His mend reports that recently he has taken large amounts of NSAIDs due to an acute baclc injury. A gastric ulcer on the posterior wall of the stomach is diagnosed by upper endoscopy. Significant findings on his admission profile are:
Vital Signs
Respiratory
• Breath sounds clear in all lung fields but diminished
Cardiovucular
• Si/S2, no murmurs
• Extremities cool, diaphoretic; pulses present but weak
Abdomen
• Distended with hyperactive bowel sounds (BSs)
• Tender right upper quadrant, no rebound tenderness
Ncurologic
• Slightly confused
•Anxious
Genitourinary
• 30 mL of amber cloudy urine following urinary catheter insertion
• Stools liquid maroon, guaiac positive
Arterial Blood Guea
Initial maaagcment of the patient with upper GI bleeding would include:
(A) Volume resuscitation
(B) Hcmodynamic stabilization
(C) Identification of the site of bleeding
(D) Initiation of treatment to control bleeding within 24 hours of admission
After the bleeding 1itc i• identifted and bleeding ia controlled, the drug of choice to treat a nonvariceal bleed is:
(A) Histamine receptor antagonists
(B) Proton pump inhibitors (PPis)
(C) Antacids
(D) Octreotide/Somatostatin