Question

Case studies for GI concept map activity

M.C is a 60y/o male patient who has been admitted with a 2 day history of hematemesis and abdominal pain. The patient reports sudden onset of sharp abdominal pain that radiates to his right shoulder. PMH of HTN. Home medications include Lisinopril 20mg daily. He reports that he has been taking ibuprofen 600mg every 6 hours for four days after sustaining an injury to his right hand playing racketball. He denies smoking. He drinks two glasses of wine daily. V/S are stable at 108/60, HR 70, RR 20 and unlabored, and O ₂ sat 96% on room air. He is receiving NS at 100 ml/ hour. Hemoglobin and hematocrit are 8.6 and 29.9.

R.G is a 70 y/o female patient who presents to the emergency department with chest pressure described as tightness that radiates to lower jaw area. She reports nausea and her skin is diaphoretic. PMH of irritable bowel syndrome and is not currently taking any medications. She reports smoking 1 pack per day of cigarettes for the last 40 years. She denies alcohol use. V/S B/P 130/70, HR 75, RR 24, and O ₂ sat 94% on room air. She is on the cardiac monitor which shows normal sinus rhythm with no arrhythmias noted. The patient has been given a “GI cocktail” containing an antacid with some effect noted.

Instructions: Describe, in the top box of the attached concept map, what the health history and physical assessment should include for patients presenting with a GI problem. In the diagnostic testing box, list the appropriate diagnostic tests for these two patients.

Please consider the information in the above case studies and using the attached concept map plot the information for M.C. and R.G in the appropriate box (either PUD or GRED). Finally, what should the education include for these patients.

GI Concept Map Activity

Assessment History Physical assessment

Education

Education

GERD

Peptic Ulcer Disease/clinical manifestations

Diagnostic Tests

Answer 1

1 ) Subjective Finding:

A 60 year of male patient who has been admitted with a 2 day history of severe abdominal pain and hematemesis.

2 ) Objective Findings:

  a) Lab investigation

• HR :70
• BP :108/60
• Hb : 8.6
• Hematocrit: 29.9
• RR : 20
• O2 sat : 96% on room air

b ) Biochemical investigation

• Endoscopy : H - pylori positive

3 ) Physical Assessment :

Peptic ulcer with hematemesis

4 ) Plan :

DRUG	DOSE	INDICATIONS	SIDE EFFECTS
Inj. Ondasetron	4mg	Anti emetic	drowsiness, headache, constipation
Inj. Omeprazole	40mg	to treat peptic ulcer	muscle aches, itching, burning urination
IVF DNS		Nutrient and electrolyte replenisher	fever, infection at the site of injection
NPO		should not take food orally
Inj. Metronidazole	500mg	for H-pylori infection	dizziness, stomach upset, metallic taste in mouth
Tab.Clarithromycin	500mg	for H-pylori infection	changein taste, heartburn

  

5 ) Patient Education :

• Avoid spicy foods.
• Unnecessary drug intake is avoided, adviced to take intermittent meals.
• Omeprazole is given for one hour before food.
• Alcohol intake during Metronidazole therapy produce Disulfiram like reaction, patient is adviced to not to take alcohol.
• Smoking may accelerate peptic ulceration and worsen the condition.
• Lifestyle modification.
• Antacid may alters absorption of other drugs.
• Do not take sodium bicarbonate with milk.Drug is soluble and has rapid absorption. The absorbed alkali decreases excretion of calcium.
• Do not take sodiumbicarbonate for more than 2 weeks , the systemic accumulation of sodium may leads to side effects such as urination, headache, vomiting.
• Do not co-administer antacid with other drugs.example :Ranitidine ,when antacids are prescribed with anti secretory drugs, advice patient to take antacids one hour before or two hour after the administration of these drugs.

​​​​​​Direction for medication :

• In day 2 Anti H-pylori drugs are started, standard H -pylori drugs are given.
• Given no , iron therapy for hematemesis.
• Ondasetron and pantoprazole given in first day for immediate management of hematemesis.
• Maintanance therapy is given -treatment.
• Treatment is effective.

Peptic ulcer is a condition in which their is discontinuity in the entire thickness of GI mucosa.It result due to an imbalance between aggressive and defensive factors.

Aggressive factors include acid, pepsin, bile, H-pylori and gastrin. Defensive include gastric mucous, bicarbonate, nitric oxide, etc..

Reason :

  H -pylori infection and use of ibuprofen and other NSAIDs.

Clinical manifestations :

Upper abdominal pain occurring 1-3 hours after meals and relieved by food and antacid is the classic syptom of peptic ulcer.

Other symptoms are ; anorexia, vomiting, heart burn.

Complications of peptic ulcer include hemorrhage, chronic iron deficiency anemia, pylori stenosis and proliferation.

Investigation :

• Endoscopy : It is the most accurate and preffered method.Biopsy may be generally used for malignancy.
• Radiology : double contrast barium radiography is used to detect 50% of peptic ulcer cases.
• H-pylori detection : serological test to detect antibodies. It is based on the detection of immunoglobulin G antibody of pylori.
• Stool antigen test : uses enzyme immuno assay to detect H-pylori antigen.
• C13 urea breath test : Based on the principle that urease activity in the stomachof infected individual hydrolyses urea in to ammonia and carbon dioxide. The test uses C13 labelled urea which when hydrolysed result in C13 carbon dioxide which appear in patents breath.

Gastroesophageal Reflux Disease (GERD) is a digestive disease in which stomachacid or bile irritates the food pipe lining.

Clinical manifestations:

• Burning pain in the chest that usually occurs after eating and worsen when lying down.
• Difficult in swallowing

Investigation methods :

• Endoscopy
• Esophageal manometry and impedance study
• PH testing

Treatment :

1. Antacids - neutralise acid in esophagus and stomach and stop heartburn.
2. H2 blockers - reduce acid in the stomach.
3. Proton pump inhibitors -These drugs block a protein needed to make stomach acid.
4. Prokinetics - These drugs helps to stomach empty fasten.