Mon22November1200AM 4

A 76-year-old lady had a GI bleed 10 months ago related to NSAID use for osteoarthritis. At that time an endoscopy showed a duodenal ulcer which was treated. She now represents with an acute haematemesis following re-prescription of diclofenac with misoprostol.

Her haemoglobin on admission is 56 g/L. OGD is performed, showing a single bleeding vessel on the posterior wall of the duodenum. Adrenaline injection and clipping fail to control the bleeding.

What is the next step in her management?

(Please select 1 option)

Urgent referral to on-call surgeons Correct

Octreotide

Terlipressin

IV Omeprazole

Repeat endscopy the next day

Explanation

This lady has lost a lot of blood and has ongoing bleeding despite endoscopic intervention. She requires urgent surgery and oversewing of the bleeding vessel. Interventional radiology for embolisation of the vessel would be a potential alternative route that could be considered depending upon availability of the service and the patient's operative risk.

It would be appropriate to use omeprazole postoperatively to promote ulcer healing. Omeprazole will not stop bleeding from a visible vessel.

Terlipressin and octreotide decrease portal blood pressure and have an established role in variceal haemorrhage, but not in peptic ulcer disease.

Answer Statistics

1

76%

2

3%

3

8%

4

12%

5

4%

Times answered: 271