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) 

b) What is your recommendation for the pharmacological management of acute GI bleeding? Please provide specific regimens and state the purpose of each of the management strategies. (6 marks) 

c) YSK eventually stabilized and is discharged home with her usual medications and oral pantoprazole. What are the possible side effects with long-term proton-pump inhibitor use? (5 marks)

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