A patient presented to emergency ward with massive upper gastrointestinal bleed. On examination, he has mild splenomegaly. In the absence of any other information available, which of the following is the most appropriate therapeutic modality ?
Ans. is 'c' i.e., Intravenous pantoprozole Maingot states "Because all sources of upper G.I. bleeding involves a disruption of mucosa, pharmacological inhibition of gastric acid secretion is provided empirically? So if the diagnosis of the patient with acute upper gastrointestinal bleeding cannot be confirmed endoscopically the patient should be given any gastric acid inhibitor (either H2 blocker or P.P.I.). This is also justified as 80% of bleeding is from non-variceal source (peptic ulcers, gastritis, esophagitis) In the question the clinical features of the patient indicates upper gastrointestinal bleeding due to peptic ulcer. Variceal bleeding due to poal hypeension is very unlikely in the absence of moderate or massive splenomegaly (presence of mild splenomegaly is not enough evidence for variceal bleeding). So the most appropriate therapy in this case is pantoprozole whether you give it empirically or as a therapy for most likely clinical diagnosis Also know, In case of variceal bleeding somatostatin is more effective than vasopressin in control of bleeding.
Intravenous propranolol
Intravenous vasopressin
Intravenous pantoprazole
Intravenous somatostatin