Bleeding Peptic Ulcer: An Emergency Room Vignette, Case Study Example

In the case scenario, a Jehovah’s Witness appears in the emergency room with a bleeding peptic ulcer. Because she refuses a blood transfusion, it is necessary to resolve her presenting problem, i.e. the bleeding, while respecting her religious beliefs. The first step would be to order a clinical and endoscopic evaluation, determining whether the patient is someone who requires active therapy as opposed to monitoring and preventive measures (Sung, 2006.) The goal is to achieve homeostasis, using a combination of medications and endoscopic therapy (a combination of injection and thermal coagulation.) Surgery would also need to be considered, since it is frequently the most efficient means of controlling bleeding. The decision about whether to proceed with surgery versus recurrent endoscopic treatment would need to be based on the patient’s pre-existing health status, as well as the specific traits of the ulcer.

Following the management of the bleeding problem, a longer-term treatment plan needs to be developed for this patient. Typically, the treatment would involve antibiotics to eliminate the bacteria as well as other medications to decrease the level of acid in the digestive system (Peptic Ulcer: Treatment and Drugs, 2011.) If the ulcer has been caused by acidity, the patient may need prescriptions for medication that will protect the lining of the stomach, reduce acid production, or drugs that will neutralize stomach acid. Proton-pump inhibitors , or PPI s, such as intravenous omeprazole, have been found to have a strong acid-suppressing effect on the stomach In addition, follow-up endoscopies should be ordered on a regular basis to monitor the status of the ulcer and to prevent it from bleeding again.

References:

Peptic Ulcers: Treatment and Drugs. (2011, January 6). Retrieved January 27, 2012, from Mayo Clinic: http://www.mayoclinic.com/health/peptic-ulcer/DS00242/DSECTION=treatments-and-drugs

Sung, J. (2006, January 13). Current Management of Peptic Ulcer Bleeding. Retrieved January 27, 2012, from Medscape Today News: http://www.medscape.com/viewarticle/52118