05-17-2007, 03:22 PM
A 41-year-old man comes to the emergency department following two episodes of "black stools" over the preceding 12 hours. He has not had hematemesis, hematochezia, abdominal pain, or weight loss. Medical history is unremarkable. His only medication is ibuprofen approximately three times weekly, which he takes for muscle aches after exercise.
On physical examination, pulse rate is 86/min, and blood pressure is 130/70 mm Hg without orthostatic changes. Rectal examination discloses melena. The remainder of his examination is unremarkable. Hemoglobin is 11.0 g/dL.
The patient is hospitalized. Upper endoscopy shows a 1-cm clean-based ulcer in the duodenum. Results of serologic studies for Helicobacter pylori are pending.
In addition to stopping the ibuprofen and beginning a proton-pump inhibitor, which of the following is the most appropriate management at this time?
( A ) Early refeeding and consideration of same-day hospital discharge
( B ) Hospital discharge in 48 hours and outpatient upper endoscopy in 6 weeks
( C ) Continued hospitalization with nothing by mouth and upper endoscopy on hospital day 2
( D ) Continued hospitalization and endoscopic treatment of the ulcer using injected epinephrine
On physical examination, pulse rate is 86/min, and blood pressure is 130/70 mm Hg without orthostatic changes. Rectal examination discloses melena. The remainder of his examination is unremarkable. Hemoglobin is 11.0 g/dL.
The patient is hospitalized. Upper endoscopy shows a 1-cm clean-based ulcer in the duodenum. Results of serologic studies for Helicobacter pylori are pending.
In addition to stopping the ibuprofen and beginning a proton-pump inhibitor, which of the following is the most appropriate management at this time?
( A ) Early refeeding and consideration of same-day hospital discharge
( B ) Hospital discharge in 48 hours and outpatient upper endoscopy in 6 weeks
( C ) Continued hospitalization with nothing by mouth and upper endoscopy on hospital day 2
( D ) Continued hospitalization and endoscopic treatment of the ulcer using injected epinephrine