07-09-2012, 06:31 AM
A 49-year-old homeless white man comes to the emergency department and says, "I began vomiting 2 to 3 hours ago, and then started to throw up blood." He reports vomiting "about half a cup" of red blood. He had epigastric discomfort after several episodes of emesis, but no preceding abdominal pain. The patient says that he drinks about a half pint of bourbon per day, and he does not use aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). He has no previous history of similar symptoms. Vital signs now are: temperature 37.0°C (98.6°F), pulse 105/min and blood pressure 150/77 mm Hg. On physical examination he is alert, oriented and disheveled, and he has the odor of alcohol on his breath. No scleral icterus is present. Abdomen is soft, with mild epigastric tenderness. Liver edge is palpated 2 cm below the right costal margin and is nontender. Bowel sounds are present. Stool is negative for occult blood. An intravenous line is started. Endoscopy confirms a tear of the gastroesophageal junction. Laboratory studies show:
Serum
Amylase
135 U/L
BUN
10 mg/dL
Creatinine
0.7 mg/dL
Na+
137 mEq/L
K+
3.3 mEq/L
Cl-
97 mEq/L
HCO-3
22 mEq/L
Blood
Hematocrit
37%
Hemoglobin
12 g/dL
WBC
12,100/mm3
Platelet count
317,000/mm3
Item 1 of 2
13. The patient says, "What are you going to do, Doc?"
Which of the following is the most appropriate next step?
A
) Cimetidine, intravenously
B
) Observation and supportive care
C
) Octreotide, intravenously
D
) Sclerotherapy
E
) Selective arterial vasopressin
Item 2 of 2
14. After 1 hour the patient's condition has stabilized. Despite your urging him to stay for further evaluation, he insists on leaving.
At this time which of the following is most appropriate to tell the patient?
A
) An elective operation should be scheduled
B
) He is at immediate risk for major gastrointestinal hemorrhage
C
) His symptoms might indicate severe alcoholic liver disease
D
) Omeprazole would help prevent further episodes
E
) The risk for rebleeding from this episode is relatively small
this is the case of mallory weiss tear ......and patient is pretty much stable in this case . what is the benifit of octreotide here ?? since this is not a source of bleeding from eophagal varices .....? wat is the managment of mallory weiss tear ......?? 1. supportive and observation ...> if still bleeding ...> Inj epinephrine ..> if still not working endoclip and embolization .
Serum
Amylase
135 U/L
BUN
10 mg/dL
Creatinine
0.7 mg/dL
Na+
137 mEq/L
K+
3.3 mEq/L
Cl-
97 mEq/L
HCO-3
22 mEq/L
Blood
Hematocrit
37%
Hemoglobin
12 g/dL
WBC
12,100/mm3
Platelet count
317,000/mm3
Item 1 of 2
13. The patient says, "What are you going to do, Doc?"
Which of the following is the most appropriate next step?
A
) Cimetidine, intravenously
B
) Observation and supportive care
C
) Octreotide, intravenously
D
) Sclerotherapy
E
) Selective arterial vasopressin
Item 2 of 2
14. After 1 hour the patient's condition has stabilized. Despite your urging him to stay for further evaluation, he insists on leaving.
At this time which of the following is most appropriate to tell the patient?
A
) An elective operation should be scheduled
B
) He is at immediate risk for major gastrointestinal hemorrhage
C
) His symptoms might indicate severe alcoholic liver disease
D
) Omeprazole would help prevent further episodes
E
) The risk for rebleeding from this episode is relatively small
this is the case of mallory weiss tear ......and patient is pretty much stable in this case . what is the benifit of octreotide here ?? since this is not a source of bleeding from eophagal varices .....? wat is the managment of mallory weiss tear ......?? 1. supportive and observation ...> if still bleeding ...> Inj epinephrine ..> if still not working endoclip and embolization .