A 43-year-old man with no diseases of interest comes to the emergency department for 4 melaenic stools in the last 12 hours. He refers taking NSAIDs in previous days. Physical examination revealed pale skin and mucous membranes. BP 95/65 and HR 110 bpm. The abdomen is not painful and rectal examination shows melenic stools. The CBC shows a Hb of 8.1 gr/dl. After infusion of saline and the start of red blood cell concentrate transfusion, the BP was 120/85 and HR 90 bpm. An endoscopy was performed in which clots were found in the stomach and a 2 cm ulcer in the gastric antrum with fibrin background and a small grayish-white protrusion of 3 mm in the center of the ulcer (visible platelet thrombus vessel). What do you think is the most correct approach?
Question about non-varicose ADH. Young patient, with no previous history, who after taking NSAIDs presents bleeding with hemodynamic instability requiring transfusion.  Answer 1 is not in accordance with what has been said, this is an unstable patient who has bled a lot, who has a Forrest IIa ulcer with a high risk of rebleeding. Answer 2 speaks of somatostatin, which is used for bleeding due to portal hypertension. 4 will only be considered if bleeding is not controlled endoscopically. Between 3 and 5, since there is a high risk of bleeding, endoscopic therapy is recommended, preferably with 2 techniques, so the correct one would be 5.
Since the patient is young, with no associated diseases and the ulcer has stopped bleeding, he can be discharged early with treatment with a PPI and H. Pylori eradication.
Remove the endoscope, place nasogastric tube for continuous aspiration and initiate treatment with a PPI and somatostatin.
Take biopsy for H. Pylori, remove the endoscope taking care not to dislodge the platelet thrombus and continue pharmacological treatment with i.v. PPI.
Consultation to the surgical service to consider urgent surgical treatment.
Endoscopic treatment by injection of adrenaline into the ulcer and placement of clips (metal staples) followed by i.v. administration of PPI.
Young patient, with no previous history, who after taking NSAIDs presents bleeding with hemodynamic instability requiring transfusion. Answer 1 is not in accordance with what has been said, this is an unstable patient who has bled a lot, who has a Forrest IIa ulcer with a high risk of rebleeding.
Answer 2 speaks of somatostatin, which is used for bleeding due to portal hypertension.
Between 3 and 5, since there is a high risk of bleeding, endoscopic therapy is recommended, preferably with 2 techniques, so the correct one would be 5.
4 will only be considered if bleeding is not controlled endoscopically.
Between 3 and 5, since there is a high risk of bleeding, endoscopic therapy is recommended, preferably with 2 techniques, so the correct one would be 5.