Mallory-Weiss syndrome Quiz: Ace Your Exams

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A 45-year-old man comes to the emergency department to be evaluated for 10-12 episodes of forceful vomiting over the past 12 hours. His vomiting began after drinking 16 beers the previous night during a celebration. He vomited 10 times, and there has been bright red blood in the vomitus for the past hour. He has no known medical conditions and takes no medications. He smokes one pack of cigarettes daily and drinks six beers on the weekends. Temperature is 36.4°C (97.5°F), pulse is 100/min, blood pressure is 125/72 mmHg, and respirations are 18/min. Cardiopulmonary examination is normal. Abdominal examination is unremarkable. There is no peripheral edema. Intravenous fluids and proton pump inhibitors are administered. Initial hemoglobin is 15.2 g/dL. Serial vital signs and hemoglobin levels are obtained and charted below. Which of the following is the best next step in management?

Time after presentation (hrs)	Blood Pressure (mmHg)	Pulse (/min)	Hemoglobin (g/dL)
2	132/76	95	13.5
4	125/72	90	12.5
6	135/75	88	12.1

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Choose an option:

Emergent upper endoscopy

Oral proton pump inhibitors and outpatient upper endoscopy within 72 hours

CT scan of the abdomen

Urgent inpatient upper endoscopy within 24 hours

Oral proton pump inhibitors and outpatient office follow-up