YSK is an 81-year-old female admitted for acute exacerbation of COPD. She has been admitted multiple times for the same condition in the past 12 months. YSK's past medical history is also significant of peptic ulcer (resolved one year ago), tuberculosis, and adrenal insufficiency on hydrocortisone. During day 3 of this hospitalization, YSK complained of epigastric pain and vomited twice. Endoscopy revealed a bleeding ulcer in the gastric antrum. 

a) Please identify all the potential risk factors in YSK for this upper gastrointestinal ("GI") bleeding. (4 marks) 

• Peptic ulcer disease - the most common cause of upper GI bleeding (H.pylori)
• Daily hydrocortisone for adrenal insufficiency
• Likely to have been given additional oral corticosteroid therapy (prednisolone) to treat uncontrolled COPD with multiple exacerbations in the past 12 months,

Should check the status of the tuberculosis, is it being treated effectively, is there any chance it could have spread to the GI thus causing GI bleeding?

Other causes of GI bleeding

• Chronic alcohol abuse
• Medications including NSAIDs, corticosteroids, anticoagulants
• Chronic renal failure
• Gastrointestinal surgery
• Chronic vomiting