Gastrointestinal Bleeding 305290.A 67-year-old woman with a history of hypertension and congestive
heart failure presents with “burning” epigastric pain that began 2 hours after
eating a meal. She states that she has had similar pain over the past several
weeks, and has been taking antacids and a medication that her primary-care
physician had prescribed with moderate relief. The pain has occurred with
increasing frequency and now awakens her from sleep. She states she came
to the ED today because the pain was not relieved with her usual medications.
She denies nausea, vomiting, diarrhea, or fever. She also denies hematemesis,
black stool, or bright red blood per rectum. On physical examination, she is
tender at the epigastrium, with an otherwise normal abdominal, pulmonary,
and heart examination. Stool guaiac tests positive for occult blood. Which
of the following is the most common serious complication of peptic ulcer
disease?
a. GI hemorrhage
b. GI perforation
c. GI penetration
d. Gastric outlet obstruction
e. Pernicious anemia
291.A 78-year-old man with a history of atherosclerotic heart disease and
congestive heart failure presents with increasing abdominal pain. The pain
began suddenly a day ago and has progressively worsened since then. He
denies nausea, vomiting, and diarrhea, but states that he had black tarry
stool this morning. He denies any history of prior episodes of similar pain.
Vitals are BP 120/65 mm Hg, HR 105 beats per minute, temperature 99°F.
The patient is at high risk for which of the following conditions?
a. Cholecystitis
b. Cecal volvulus
c. Mesenteric ischemia
d. Perforated peptic ulcer
e. Small bowel obstruction