sunny2
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Jessica Simpson 62.5 year, female patient presents with a Duodenal Ulcer with melaena and hemetemesis requiring admission to the hospital. past medical history is admission for COPD thrice in last 1 year ,Which of the following is the Most Important consideration favoring early surgical intervention ?
1. Ulcer is over 1.5 cm in diameter
2. patient is female
3. patient is 62.5 years
4. patient is a well known personality
5. patient's blood group is O -ve
6. previous acid secretory studies indicated a high acid output
7. past frequent history of COPD
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| frank100
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clueless...
I´m just trying to figure out, how to associate PUD and COPD, in order to make a guess, but I just can´t.
(7)?
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| study_ing
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i guess 1..
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| study_ing
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2 and 3 hopefully arent really important
4 is definitely out
her blood droup wont change with surgery!! ( besides gp a= gAstric= risk of cancer )..here i guess the risk wud be 1) hypovolemia etc and 2) perforation
6. high acid output wud point towards relevant medical management or the need to search eg for a gastrinoma
hmm 7 im stuck..cud be my second guess..but i cant pinpoint the link
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| frank100
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but a bleeding ulcer is not a surgical indication, only if it gets perforated, but the question is not giving too much importance to the physical exam. so you coud be right study_ing. But really this question is one of those that makes you mandile touch the floor.
i´m between 1 and 7 too. humm...
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| frank100
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you can treat a bleeding ulcer endoscopically
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| sunny2
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size or site of a bleeding duodenal ulcer does not sway the management decisions nor does the previous hospitalisation for COPD
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| study_ing
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ure too good sunny 2!
a blessing for the forum!
im lost!
then age perhaps...coz if she's old we shudnt leve her bleeding very long..wih concominant COPD anemia aint welcome
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| study_ing
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or maybe it is copd hehe
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| sunny2
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study_ing, you are spot on there.....wonderful thought...concept is the elderly tolerate major hamodynamic changes less well then young patients therefore age over 60 is a very common and important consideration in early surgical intervention, and so is the most important consideration among all those listed above
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| icemaiden
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nice question. great deduction study_ing. ice
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