A 70-year-old man presents with dyspepsia, weight loss, and a single episode of melena. He has a past medical history of peptic ulcer disease and atrial fibrillation, for which he takes warfarin. What are the potential diagnoses and next steps?
This patient's dyspepsia, weight loss, and melena suggest upper gastrointestinal bleeding, possibly from a peptic ulcer. Given his use of warfarin, an anticoagulant, the risk of bleeding is increased. Initial management should include checking his INR and possibly reversing his anticoagulation depending on the severity of the bleeding. He should be started on a proton pump inhibitor, and emergent gastroenterology consultation should be obtained for upper endoscopy. Given his weight loss, biopsies to rule out malignancy might be considered depending on endoscopic findings.