Mr. B is a 57-year-old man who was admitted yesterday after starting to pass black stools. He has a two-day history of s

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Mr. B is a 57-year-old man who was
admitted yesterday after starting to pass black stools. He has a
two-day history of severe stomach pains and has suffered on and off
with indigestion for some months. He is a life-long smoker, with
mild chronic cardiac failure (CCF) for which he has been taking
enalapril 5 mg twice daily for 2 years.
He also recently started taking naproxen 500 mg twice daily for
arthritis. Yesterday his haemoglobin was reported as 10.3 g/dL
(range 12–18 g/dL), platelets 162 × 109/L (range 150–450 × 109/L),
INR 1.1 (range 0.8–1.2) with U+Es and LFTs normal. He was mildly
tachycardic (87 bpm) and had a slightly low blood pressure of
115/77 mmHg and was given 1.5 L of saline. He has just
returned from endoscopy this morning and has been newly diagnosed
as having a bleeding duodenal ulcer. He has been written up for his
usual medication for tomorrow if he is eating and drinking
again.
Question.
1a What risk factors does Mr. B have for a bleeding peptic
ulcer?
1b State with three reasons if his
treatment so far has been appropriate?
2 Should Mr. B be given a proton pump inhibitor (PPI)? State
your reasons. If yes,
what would you recommend?
3. What is likely to be the next stage of treatment for Mr.
B?