Question

please this is a case study of peptic ulcer disease under therapeutics

CASE 1

ASM is 35-year-old accountant, presents with a week history of heartburns, pain at the umbilical region relieved both by eating and taking Mist Mag Trisilicate suspension. Most at times the pain is spontaneous at night. She has not noticed darkening of stool or the presence of blood in her stools. She has no other medical problem and is a non-smoker. Her use of NSAIDS is limited to ibuprofen 200-400mg, for her monthly dysmenorrhoea, but she does not take ibuprofen more than three times a week.

      Attempt the all questions

1. What is the likelihood that this patient has peptic ulcer?
2. What kind of peptic ulcer is she likely to suffering from?
3. State four differences between duodenal ulcer and gastric ulcer
4. Is there the need for Pylori detection test? Explain
5. Should ASM discontinue using Ibuprofen? Explain and provide recommendations.
6. What medicines would you recommend for the management of ASM’s peptic ulcer?
7. What parameters should be monitored to determine ASM’s response to treatment?
8. List counselling points for ASM

Answer 1

#. The likelihood that this patient has peptic ulcer is indicated by the signs and symptoms represented by the patient .

#. The kind of peptic ulcer she is likely suffering from is NSAIDS induced peptic ulcer .

#. Difference between duodenal and gastric ulcer :-

Gastric Ulcers

1.Lesion

2. Location of lesion

3. Gastric secretion

4. Incidence

5. Clinical manifestations

6. Recurrence rate

7. Complicatons

lesions :-

1. superficial

2. smooth margins

3. round, oval or cone shaped

location of lesion :-

predominantly in antrum, also in body of fundus of stomach

gastric secretion :-

normal to decreased

incidence :-

1. greater in women

2. more common in persons with low socioeconomic status

3. increased with smoking, drug use (NSAID and aspirin) and alcohol use

4. increased with incompetent pyloric sphincter and bile reflux

clinical manifestations :-

1. burning or gaseous pressure in high left epigastrium and back and upper abdomen.

2. pain 1-2 hours after meals; if penetrating ulcer, aggravation of discomfort with food

3. occasional nausea and vomiting and weight loss

recurrence rate :-

High

complications :-

- hemorrhage

-perforation

- gastric outlet obstruction

-intractability

#. Duodenal ulcer

lesion :-

-penetrating (associated with deformity of duodenal bulb from healing recurrent ulcer

location of lesion :-

First 1-2 cm of duoden

gastric secretion :-

Increased

incidence :-

-greater in men but increasing in women especially around postmenopausal

-peak age 34-45 yr

-associated with psychologic stress

-increased w/ smoking, drug use, and alcohol use

-associated with other disease

clinical manifestions :-

1. -burning

-cramping

-pressure like pain across midepigastrium and upper abdomen

-back pain with posterior ulcers

2. pain 2-4 hours after meals and midmorning, midafternoon, middle of night, periodic and episodic

3.pain relief with antacids and food; occasional N&V

recurrence rate - high

complications :-

1. hemorrhage

2. perforation

3. obstruction

#. Yes , pylori test is done to: Find out whether an infection with H. pylori bacteria may be causing an ulcer or irritation of the stomach lining (gastritis).

#. Yes ,ASM should stop using ibuprofen because mostly the cause behind her ulcer is excessive use of NSAIDS .

#. Treatment would include medication to decrease stomach acid production and stopping the use of NSAIDS .

Usually Medications include :-

Antibiotics, Proton-pump inhibitor, Penicillin, Antidiarrhoeal and Antacid

#. Parameters monitored :-

- relieve in symptoms

- stool sample for occult blood

- monitor for complaints of anorexia , nausea , vomiting etc

#. Counselling for ASM :-

>diet and lifestyle changes (different triggers that worsen irritation)

> Use of Acetaminophen instead of NSAIDS for pain

>low fat

>no spicy foods

>limit caffeine and alcohol