Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Coffee Ground Emesis?
Question: A 58 yo woman with rheumatoid arthritis presents to the ER after a long history of NSAID use along with 81 mg ASA daily with coffee ground emesis and abdominal pain.
What is the diagnosis and how should she be treated
What is the diagnosis and how should she be treated
Brief Answer:
Bleeding is likely
Detailed Answer:
Hello,
coffee ground emesis denotes upper gastrointestinal bleeding. Urgent investigation is needed. A fast way to check for bleeding is to insert a Levin tube in the stomach and aspirate its contents.
The best way is endoscopic evaluation because a bleeding site can be treated during endoscopy.
NSAID and ASA use predisposes to gastrointestinal bleeding and has to be stopped.
"Nil by mouth" is usually ordered and fluid administration is employed to compensate for the lost volume.
Proton pump inhibitors are employed too in high doses to reduce gastric acidity, which reduces the ability of the stomach to heal.
Contact me again, if you'd like to ask for clarifications.
Kind Regards!
Bleeding is likely
Detailed Answer:
Hello,
coffee ground emesis denotes upper gastrointestinal bleeding. Urgent investigation is needed. A fast way to check for bleeding is to insert a Levin tube in the stomach and aspirate its contents.
The best way is endoscopic evaluation because a bleeding site can be treated during endoscopy.
NSAID and ASA use predisposes to gastrointestinal bleeding and has to be stopped.
"Nil by mouth" is usually ordered and fluid administration is employed to compensate for the lost volume.
Proton pump inhibitors are employed too in high doses to reduce gastric acidity, which reduces the ability of the stomach to heal.
Contact me again, if you'd like to ask for clarifications.
Kind Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you! What would you say would be the best PPI to use and dose/duration?
Also, is her bleeding related to Peptic ulcer disease related to the NSAID use?
Also, is her bleeding related to Peptic ulcer disease related to the NSAID use?
Brief Answer:
Intravenous administration
Detailed Answer:
Hi,
I've noted that I've also answered your other follow-up question regarding GERD. I accidentaly answered that question with the answer I should have given to this one (I mentioned intravenous adminstration for GERD which is wrong!). 20mg of omeprazole is fine as a conservative treatment of GERD. It can be given twice daily if esophagitis is also present.
Regarding upper gastrointestinal bleeding, intravenous administration is required (and this is correct!).
40mg twice daily is appropriate.
I'm sorry, I mixed the answers! I hope it's clear now.
Kind Regards!
Intravenous administration
Detailed Answer:
Hi,
I've noted that I've also answered your other follow-up question regarding GERD. I accidentaly answered that question with the answer I should have given to this one (I mentioned intravenous adminstration for GERD which is wrong!). 20mg of omeprazole is fine as a conservative treatment of GERD. It can be given twice daily if esophagitis is also present.
Regarding upper gastrointestinal bleeding, intravenous administration is required (and this is correct!).
40mg twice daily is appropriate.
I'm sorry, I mixed the answers! I hope it's clear now.
Kind Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you! I was a little confused at first but I thought you were onto something so I started researching. :) Thank you for the clarification.
As far as the GI bleed, once the bleed is contained, would her diagnosis change and/or would she then be on PPI prophylactically?
As far as the GI bleed, once the bleed is contained, would her diagnosis change and/or would she then be on PPI prophylactically?
Brief Answer:
Of course
Detailed Answer:
I'm glad it's clear!
Continued use of proton pump inhibitors (PPI) is advised. Since rheumatoid arthritis is a chronic condition that cause pain and she'll have to use analgesics in the future, using PPI is essential to reduce the risk of bleeding.
If she also has Helicobacter pylori in the stomach, then eradication is also needed.
Kind Regards!
Of course
Detailed Answer:
I'm glad it's clear!
Continued use of proton pump inhibitors (PPI) is advised. Since rheumatoid arthritis is a chronic condition that cause pain and she'll have to use analgesics in the future, using PPI is essential to reduce the risk of bleeding.
If she also has Helicobacter pylori in the stomach, then eradication is also needed.
Kind Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you, Dr. Panagiotis Zografakis! Much more clear. I appreciate it.
You'll notice I have one more listed. :) That Case Study has a little more to it though with his smoking history and caffeine intake.
You'll notice I have one more listed. :) That Case Study has a little more to it though with his smoking history and caffeine intake.
Brief Answer:
You're welcome!
Detailed Answer:
You're welcome! I'll look at it, if somebody else won't answer in the meantime!
You're welcome!
Detailed Answer:
You're welcome! I'll look at it, if somebody else won't answer in the meantime!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Great, Thank you! I'm so glad I found this site. :)
Brief Answer:
Thank you for asking
Detailed Answer:
I've already answered your other query, so please have a look at my answer, and thank you for asking!
Thank you for asking
Detailed Answer:
I've already answered your other query, so please have a look at my answer, and thank you for asking!
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
