Question

Luanne lin, age 83 was brought into the emergency department with upper gastrointestinal bleeding. She said she did not have any pain but "all of a sudden I coughed and then I started to choke up bright red blood" By the time she reached the hospital, the bleeding had stopped. Her blood test results showed no abnormalities in coagulation. Her red blood cell count was 3.5K/cmm (normal 4.00-5.20 K/cmm), but all other values were in the normal range. her blood pressure was 110/70 mmHg standing. In Ms. Lin's purse was a pack of cigarettes and in her wallet was a list of her prescription medications.

-spironolactone/HCTZ ,25mg/25mg: take in a.m. for hypertension

-sertraline (generic Zoloft) 25mg: take in a.m. for depression

-OTC nicotinic acid, 50mg: Take in p.m for high triglycerides

"The other pills I take are in the bag that my daughter is bringing in. I can't remember just now what else I take- I feel so lightheaded!"

Ms. Lin was given an IV infusion of normal saline. She was prepared for an endoscopic exam of her esophagus, stomach, and duodenum-an upper GI. A topical anesthetic was sprayed in the back of her throat, and she was given an IV sedative (propofol) to relax her and suppress her gag reflex. The gastroenterologist then threaded the endoscope into Ms. Lin's mouth, down her esophagus to her stomach and duodenum

Pylorus and clean ulcer crater were spotted in the endoscope. There was no active bleeding or clot so the area was not treated. A biopsy was removed for further analysis.

A photomicrograph of the gastric biopsy specimen high power shows inflammation and gram-negative bacteria.

1. Why was Ms.Lin given an IV infusion of normal saline?

2. What problem does Ms.Lin have?

3. What is the cause of Ms. Lins's problem?

4. What medications and self-medication behaviors can cause/aggravate her problem?

5. How will Ms. Lin's problem be treated?

Answer 1

1. Intravenous infusion of normal saline was given to Ms Lin to restore the blood volume, early symptom of hypovolemia can be seen as the patient stated that "she is feeling lightheaded" as she lost some blood through bleeding.

2. The biopsy from the stomach shows gram-negative bacteria and inflammation in the gastric region with clean ulcer crater indicates that Ms Lin was suffering from gastric ulcer.

3. Campylobacter pylori which are also called Helicobacter pylori are the gram-negative bacteria which is found in the stomach causes mucosal damage. This causes gastric ulcer and further complication of this bacteria is gastric cancer.

4. Taking nicotinic acid increases the risk of gastric ulcer. Smoking reduces the antibiotic efficacy which increases the risk for Helicobacter pylori infection.

5. Antibiotic therapy to treat bacterial infection. Pantoprazole which is a proton pump inhibitor can be given to treat the ulcer is the medical management which can be used for Ms Lin's problem. Smoking and nicotinic acid intake must be stopped for better prognosis and to prevent the recurrence of the ulcer in future.