Question

A patient presents with 2 episodes of bloody vomit, a blood pressure of 100/80, a heart rate of 116, mild epigastric tenderness, and a negative fecal occult blood test (FOBT). What is the next best step in management?

1) Upper endoscopy
2) CT scan of the abdomen
3) Administer intravenous fluids
4) Start proton pump inhibitor (PPI) therapy

Answer 1

The next best step in managing a patient with episodes of bloody vomit, mild epigastric tenderness, and negative FOBT is to perform an upper endoscopy. This test helps in directly visualizing the upper GI tract and diagnosing the cause of bleeding, such as peptic ulcers.

Step-by-step explanation:

The next best step in management for a patient presenting with bloody vomit, a blood pressure of 100/80, a heart rate of 116, mild epigastric tenderness, and a negative fecal occult blood test (FOBT) would be to perform an upper endoscopy. This procedure, as shown in Figure 18.7.3, involves the insertion of a tiny camera through a tube to examine the patient's upper GI tract. The presence of bloody vomit suggests a possible upper gastrointestinal source of bleeding which requires visualization to diagnose and manage appropriately. Upper endoscopy allows for direct visualization of the stomach and duodenum and can identify the source of bleeding, such as peptic ulcers or other lesions. Given the patient's tachycardia and hypotension, administration of intravenous fluids should also be considered to stabilize the patient's hemodynamic status. Although a proton pump inhibitor (PPI) and intravenous fluids are part of the management, they are adjuncts to the diagnostic procedure and do not replace the need for upper endoscopy which is the primary diagnostic step.