Eddie Jones, a 78-year-old veteran, presents to clinic requesting something stronger for heartburn. A quick review of his health record reveals a history of recurrent bleeding duodenal ulcers starting 20 years ago. However, since treatment for Helicobacter pylori in 1989 he has been without problems. He says he first noticed this new problem about 6 weeks ago and OTC H2 blockers have not helped very much. He has been taking ibuprofen 400 mg three to four times a day for the last year for “old age” aches and pains.
a. List three likely causes for Eddie’s problem. Explain your rationale.
b. List four examinations, questions, or laboratory tests you would perform to differentiate between the probable causes listed above. Explain your rationale.
c. Just as you complete your interview, Eddie mentions that he has noticed his stools are much darker than usual and is concerned about a recurrence of his bleeding ulcers. List four questions, examinations, or laboratory tests that would help determine if Eddie is bleeding from his upper gastrointestinal tract.
