Professional Documents
Culture Documents
Day 1 Mrs GE, an 86-year-old Caucasian woman, was taken to A&E from her care
home. She had a 1-week history of tiredness, weakness, and some epigastric
discomfort and nausea. She had one episode of melena the previous day and coffee
ground vomit earlier today. Her past medical history included osteoarthritis, gout,
hypertension, and resting tremor secondary to anxiety. She had no known drug
allergies and was taking the following prescription drugs:
Propranolol 40 mg up to three
times daily when required
Arthrotec (diclofenac 50 mg +
misoprostol 200 micrograms)
tablets twice daily
Her blood pressure was recorded as 115/59 mmHg, her respiratory rate was 24 and
her pulse rate 155 beats per minute (bpm). A provisional diagnosis of upper
gastrointestinal (GI) bleeding was made and she was admitted to the ward.
Q1
How serious is the bleed?
Q2
What immediate treatment options should be considered?
Q3
How would you treat this patients (a) shock and (b) symptoms?
Q4
How would you suggest Mrs GEs current drug therapy be managed acutely?
Q5
What is the mechanism for non-steroidal anti-inflammatory (NSAID)-induced
ulcers?
Q6
How effective is misoprostol at preventing NSAID-induced peptic ulcers?
Q7
How can the cause of the bleed be confirmed, the bleeding stopped, and rebleeding prevented?
An urgent endoscopy was arranged for Mrs GE.
Q8
Q9
Q10
An endoscopy was performed and active duodenal bleeding was noted and treated.
Following the procedure Mrs GE was admitted to the medical high-dependency unit.
The consultant wanted an acid-suppressing drug to be prescribed.
Q11
Which acid-suppressing drug, and what dose regimen and route would you
suggest? What evidence is there to support your recommendation? What
alternatives could be used?
Q16
Q17
Q18
In the patients discharge letter, what would you recommend the general
practitioner (GP) prescribe to eradicate the H. pylori?
Should Mrs GE be prescribed iron therapy, and if so, for how long?
What counselling should Mrs GE be given in preparation for discharge to
optimise successful treatment and adherence to treatment?
Mrs GE completed the H. pylori eradication therapy and remained well and
symptom free. Her care home arranged for her to be reviewed by her GP.
Q19 Should the GP check to see whether the H. pylori eradication was successful?
If so, how?
Q20 How long does Mrs GE need to be prescribed a proton pump inhibitor (PPI)?
Mrs GE told the nursing staff in her home that her knees were painful, and that she
was worried that the gout in her toe would return.
Q21
Q22