jakstat

10+ Year Member
7+ Year Member
Aug 23, 2008
85
0
141
Status
Medical Student
I just got this question on comquest. States that a pt under 70y/o with perf ulcer can be managed medically vs surgery! Maybe i'm getting stupider the more I study, but this is the first I've heard of this.
 

ShyRem

I need more coffee.
Moderator Emeritus
10+ Year Member
Jun 17, 2004
9,798
126
481
Where I hang my hat.
Status
Attending Physician
I would give specifics, but I seem to recall you think I'm a troll. :rolleyes:

So instead, let me refer you to an objective reference: uptodate.com. It has all the information you require.
 

jakstat

10+ Year Member
7+ Year Member
Aug 23, 2008
85
0
141
Status
Medical Student
Dont respond to my thread then... Oh maybe the answer is in the NBOME PE video. I'll go check that right now.
 

ShyRem

I need more coffee.
Moderator Emeritus
10+ Year Member
Jun 17, 2004
9,798
126
481
Where I hang my hat.
Status
Attending Physician
*sigh* I'll ignore the PE exam comment. I did sign an agreement not to disclose specifics of the exam, and I did my best to stick to that. I gave the biggest hints and tips I could within that agreement.

It occurred to me that perhaps you don't have access to uptodate. Someone reminded me that some hospitals are dumping their subscription due to high expense - something like $50+K/yr for a hospital.

I checked B&W, and sure enough it doesn't say anything about medical management for perforated ulcer. I didn't check Pocket Medicine. Tarascon Internal Medicine has specific criteria to rank risk for PUD and suggests medical management for those with adequate scores. However, keep in mind that on the COMLEX, generally the best answer will be the cheapest, least invasive.

In the case of perforated ulcer, medical management consisting of IV fluids, NG suction, ABX, and something like a PPI can lead to quickly healing perfed ulcers. Some hospitals use sucralfate as well. Such conservative medical management can lead to a 60-70% reduction in surgery for perforated ulcers, but at a cost of a slightly longer hospital stay. For an unspecified reasons, patients over 70yo did not respond quite as well to medical management as those under 70yo.
 
Last edited:

Jonathan13180

Senior Member
7+ Year Member
15+ Year Member
Jan 30, 2004
280
0
0
Visit site
Status
Well answered shyrem...I would also add, like most every situation, that if the pt is unstable, then surgery it is.
Goodluck jakstat,

*sigh* I'll ignore the PE exam comment. I did sign an agreement not to disclose specifics of the exam, and I did my best to stick to that. I gave the biggest hints and tips I could within that agreement.

It occurred to me that perhaps you don't have access to uptodate. Someone reminded me that some hospitals are dumping their subscription due to high expense - something like $50+K/yr for a hospital.

I checked B&W, and sure enough it doesn't say anything about medical management for perforated ulcer. I didn't check Pocket Medicine. Tarascon Internal Medicine has specific criteria to rank risk for PUD and suggests medical management for those with adequate scores. However, keep in mind that on the COMLEX, generally the best answer will be the cheapest, least invasive.

In the case of perforated ulcer, medical management consisting of IV fluids, NG suction, ABX, and something like a PPI can lead to quickly healing perfed ulcers. Some hospitals use sucralfate as well. Such conservative medical management can lead to a 60-70% reduction in surgery for perforated ulcers, but at a cost of a slightly longer hospital stay. For an unspecified reasons, patients over 70yo did not respond quite as well to medical management as those under 70yo.