An 85 year-old woman is taking aspirin after by Dr. Laurence Bailen

Question 8 / 32: An 85 year-old woman is taking aspirin after recently suffering a myocardial infarction. She is admitted to the hospital from the nursing home with coffee ground emesis and several days of black stool. She is found to be hypotensive in the emergency room and severely anemic. She receives intravenous fluid, packed red blood cell transfusions, and pantoprazole intravenously. Once she is stabilized, an upper endoscopy is performed. Multiple small gastric ulcers are seen in the gastric antrum. They are all superficial and not actively bleeding.

Which of the following is the most likely cause for this patient’s ulcers?

h.pylori infection

Lack of gastric mucus

Exuberant blood supply to stomach

Inhibition of cyclooxygenase

Very high gastric acid production

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Explanation:

Effect of aspirin is the most important factor in ulcerogenesis in this situation. H.pylori is not as common a cause of gastric ulcers compared to duodenal ulcers. Gastric mucus is not affected in this situation. An exuberant blood supply is protective. High gastric acid production is not typically seen in NSAID induced ulcers.

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Gastrointestinal Pathophysiology Self-Assessment

Author:

Dr.Laurence BailenProfessor

Tufts University School of Medicine

USA

Access: Public

Attribution: Laurence Scott Bailen, Tamsin Knox, Paul Abourjaily, Fredric D. Gordon,Marshall Kaplan,Andrew G. Plaut. PPY 222 Gastrointestinal Pathophysiology, Spring 2007. (Tufts University OpenCourseWare), http://ocw.tufts.edu/Course/47 (Accessed 3 May, 2014). License: Creative Commons BY-NC-SA

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