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Pcp Case Study

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Patient should be discharged on single daily dose oral PPI for a specific duration and schedule an appointment with PCP in one week.
The need for NSAIDs should be carefully evaluated in patients with NSAID-associated bleeding ulcers. Those who need NSAIDs, a COX-2 selective NSAID like Celecoxib is recommended at the lowest effective dose along with a PPI (27).
Mortality was significantly associated with rebleeding, age > 60 years, and the finding of blood in the stomach at endoscopy. Rebleeding was significantly associated with melena, identification of a gastric or duodenal ulcer, endoscopic stigmata of hemorrhage such as blood, clot, and active bleeding, and features of shock at the time of admission (28).
AIMS65 is a scoring system with high accuracy for predicting inpatient mortality among patients with UGIB. Five factors associated with increased mortality are Albumin less than 3.0 g/dL, INR greater than 1.5, Altered Mental status, Systolic blood pressure of 90 mmHg or less and Age > 65 years. Increasing score predicts mortality, increased length of hospital stay and cost (29).
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Complications and comorbidities of upper GI bleed should also be documented along with the etiology to allow coding to reflect accurate severity and to ensure appropriate DRG classification.

In conclusion this case demonstrates the potential opportunities for the better management of patients with upper gastrointestinal bleed, including adhering to guideline-directed therapy, improving transition of care and proper documentation, which can result in better patient outcomes, lower readmissions due to rebleeding and higher
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