Question

A 50-year-old advertising executive consulted his primary health-care provider because of tiredness, lethargy, and an abdominal pain centered around the lower end of his sternum, which woke him in the early hours of the morning. The pain was relieved by food and antacids. His uncle had died of stomach cancer and he was worried that he had the same illness. On examination his doctor noted that he seemed a bit pale and that he had a tachycardia. His blood pressure was low. He was slightly tender in his upper abdomen but there was no guarding or rebound tenderness. The doctor took blood and feces samples and organized for an upper gastrointestinal endoscopy. The gastroscopy showed a 3 cm ulcer in the prepyloric region of the stomach. A fecal antigen test was taken for further analysis.

Lab Results:

• Gram-stains revealed non-spore forming, motile, gram-negative bacterium with a helical shape
• When placed under environmental stress, the bacterium converted to a coccoid morphology possibly due to an evolutionary adaptation
• Cultures taken revealed a micro-aerobic organism on horse blood agar
• Fermentation tests revealed an ability to metabolize glucose
• Biochemical tests further displayed that the organism was catalase and oxidase positive

Diagnosis:

• Epigastric pain
• Heartburn
• Anemia
• Ache and burning in abdomen
• Abdominal pain that worsens when hungry
• Ulcers in prepyloric region of stomach

Can you give a detailed explanation of the symptoms the 50-year-old patient is having?

Answer 1

• According to my view , the 50 year old patient is having Peptic ulcer.
• Because it is clearly mentioned in the lab reports that a gram negative bacterium with a helical shape is present. That is Helicobacter Pylori , which is the main etiology of peptic ulcer.
• Peptic ulcer is a sore that develops on the lining of the oesophagus, stomach and small intestine.
• Ulcer occurs when stomach acid damages the lining of the digestive tract.

TYPES

1. Gastric ulcer
2. Duodenal ulcer

GASTRIC ULCER

• It occurs on the inside of the stomach

DUODENAL ULCER

• It occurs on the inside of the upper portion of the small intestine.

ETIOLOGY

Most common causes are

• Infection with Helicobacter pylori
• Long term use of NSAIDs such as ibuprofen and naproxen sodium.

SYMPTOMS

• Burning stomach pain
• Feeling of fullness, bloating, or belching
• Intolerance to fatty foods
• Heartburn
• Nausea

RISK FACTORS

• smoking
• Drinking alcohol: alcohol can irritate and erode the mucuos lining of the stomach, and it increases the amount of stomach acid that is produced.
• Eat spicy foods.

TREATMENT

1. Reduction of gastric acid secretion

• H2 anti histamines- ranitidine, cimetidine, famotidine
• Proton pump inhibitors- omeprazole, esomeprazole, pantoprazole
• anticholinergic drugs- pirenzipine, propantheline
• prostaglandin analogue- misoprostol

2. Neutralization of gastric acids

• Systemic- sodium bicarbonate, sodium citrate
• Non systemic- magnesium hydroxide, magaldrate, aluminium hydroxide

3. Ulcer protectives

• sucralfate, colloidal bismuth subcitrate

4. Anti H.pylori drugs

• amoxicillin, clarithromycin, metronidazole, tinidazole, tetracycline