Question

A 65-year-old woman presents with a 3-week history of stomach pain. Her family history is remarkable for her father's death due to prostate cancer and the deaths of her mother and sister due to breast cancer. Her 2 brothers experienced myocardial infarctions; both of them have had coronary bypass operations. The patient suffers from hypertension, hyperlipidemia, and coronary heart disease. She underwent angioplasty and stent placement 1 year prior to presentation. She denies having any GI problems in the past.

Her daily medications include aspirin (81 mg daily), simvastatin (3 x 5 mg daily), metoprolol (3 x 50 mg daily), vitamin E (400 I.U. daily), and a multivitamin supplement. In addition, for the past 12 weeks, she has been taking diclofenac (3 x 50 mg daily) for osteoarthritis of the right knee. She admits to sometimes taking up to 5 x 50 mg of diclofenac for management of intense pain. She states that she always used to be constipated; lately, her stool is occassionally black.

Her temperature is 36.8° C, blood pressure is 135/90 mm Hg, pulse rate is 105/min, and respiratory rate is 18/min. Physical examination reveals an obese, pale woman in no apparent distress. ECG shows slight ST depression and atrial fibrillation. There is pain upon pressure in the epigastric area. The rest of the examination is unremarkable.

Lab analysis is as follows: hemoglobin 10.8 g/dL (normal 14 to 18 g/dL); hematocrit 35.2% (normal 42% - 52%); mean corpuscular volume 92 μm3 (normal 80 - 94 μm3), white blood cell count 26,900/mm; and platelet count 233,000/mm3.

What is the most appropriate next step?
1. Gastroscopy
2 Colonoscopy
3 Helicobacter pylori treatment
4. Barium X-ray
5. Rectosigmoidoscopy

Answer 1

The most appropriate next step for this patient is a gastroscopy, as her symptoms and risk factors warrant further evaluation to rule out gastrointestinal bleeding.

Step-by-step explanation:

The most appropriate next step for this patient is:

Gastroscopy

The patient's symptoms, such as abdominal pain and black stools, along with the presence of risk factors like family history of cancer and cardiovascular disease, warrant further evaluation to rule out gastrointestinal bleeding.

A gastroscopy, also known as an upper endoscopy, is a procedure in which a flexible tube with a camera is inserted through the mouth into the stomach and upper part of the small intestine to visualize the upper digestive tract. This can help identify any potential source of bleeding or other abnormalities in the stomach or esophagus.