A 65 years old woman with known duodenal ulcer being treated by H2 blocker therapy is admitted with upper gastrointestinal bleeding. After blood replacement is begun the next step in her management should be:
The patient may be treated by endoscopy. Several endoscopy devices can deliver thermal energy required to achieve coagulation. Transendoscopic bipolar electrocoagulation and heater probe therapy can decrease rebleedillg rates and the need for surgical intervention by up to 50%. Previously in aged patients surgery was done to stop bleeding. The bleeding vessels were ligated by non absorbable suture. With the advance of erdoscopic technique surgery is now done less commonly. However if endoscopic management fails to stop bleeding then surgery will be required.
Institute anti H. pylori treatment
Repeated gastric lavage
Endoscopy and coagulation of bleeding vessel
Pylor duodenotomy and oversewing of the bleeding