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Peptic Ulcer Disease

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by

Heather Hartman

on 30 August 2013

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Transcript of Peptic Ulcer Disease

Peptic Ulcer Disease
Heather Hartman
Shane Martineau
Erika Prouty
Maureen Riley
Jeremy Schongar
Subjective: PUD
JW is a 67 year old female
"My stomach has been hurting really badly for the past month or so. It seems to get worse at night."
Complains of episodic epigastric pain for the past 6 weeks
Non-radiating pain
Pain is sometimes worse with meals, but sometimes eating helps improve pain
Occasional nausea, bloating, and heartburn
Denies color change or frequency in BM
No history of PUD or GI bleeding
Has had frequent HA for the past month for which she has taken naproxen 1-2 times daily
Objective: PUD
Subjective: PUD
PMH
CAD x 1 year (s/p Taxus stents x 2)
Hypothyroidism x 22 years
Hyperlipidemia x 10 years
Lactose intolerance x 47 years
Postmenopausal; LMP 13 years ago

Medications (NKDA)
Plavix 75mg po daily
Lisinopril 5mg po daily
ASA 325mg po daily
Hyperthyroid 125mcg po daily
Simvastatin 40mg po daily
MVI tablet po daily
Tums 500mg po prn stomach pain
Naproxen 220mg po prn HA
Lactaid tablet po prn dairy product consumption

Subjective: PUD
SH: Married with 3 children; not employed outside of the home; non-smoker; has 1-2 glasses of wine most days of the week

FH: Non-contributory in regards to PUD and HA
Physical Exam
GEN: slightly overweight, moderate distress
VS: BP 110/72 P 99 RR 16 T 37.2°C
Wt 68kg Ht 5'3"
HEENT: normocephalic; PERRLA; EOMI
CHEST: CTA
CV: RRR, S1 and S2 normal, no MRG
ABD: soft; mild epigastric tenderness; (+)BS; no
splenomegaly or masses; liver size normal
RECT: nontender; stool heme (+)
EXT: normal ROM; no CCE
NEURO: CN II-XII intact; A&O x3
Objective: PUD
Labs
Na 142 K 4.7 Cl 98 CO2 30 BUN 8
SCr 0.7 Ca 9.5 Mg 2.2 Phos 3.8
Alb 5.0
Hgb 10.1 Hct 30% Plt 320 WBC 7.6
MCV 72 Retic 0.4% Fe 48 FBG 92

Problem List:
1. Peptic Ulcer Disease
2. Headache (Naproxen use)
Assessment: PUD
JW could be presenting to her PCP with a duodenal ulcer which is supported by:
epigastric pain sometimes relieved after eating
bloating
heartburn

There is also a possibility that JW could be experiencing a gastric ulcer. This is supported by:
concurrent NSAID use (Naproxen and ASA)
pain sometimes worse with meals

To confirm her diagnosis, there are a couple of tests that can be performed:
EGD (confirm location)
Rapid urease breath test (determine if it is H. pylori)
Subjective: HA
JW is a 67 year old female
Has had frequent HA for the past month for which she has taken naproxen 1-2 times daily

SH: Married with 3 children; not employed outside of the home; non-smoker; has 1-2 glasses of wine most days of the week

FH: Non-contributory in regards to PUD and HA
Subjective: HA
PMH
CAD x 1 year (s/p Taxus stents x 2)
Hypothyroidism x 22 years
Hyperlipidemia x 10 years
Lactose intolerance x 47 years
Postmenopausal; LMP 13 years ago

Medications (NKDA)
Plavix 75mg po daily
Lisinopril 5mg po daily
ASA 325mg po daily
Hyperthyroid 125mcg po daily
Simvastatin 40mg po daily
MVI tablet po daily
Tums 500mg po prn stomach pain
Naproxen 220mg po prn HA
Lactaid tablet po prn dairy product consumption


Objective: HA
Physical Exam
GEN: slightly overweight, moderate distress
VS: BP 110/72 P 99 RR 16 T 37.2°C
Wt 68kg Ht 5'3"
HEENT: normocephalic; PERRLA; EOMI
CV: RRR, S1 and S2 normal, no MRG
EXT: normal ROM; no CCE
NEURO: CN II-XII intact; A&O x3
Labs
Na 142 K 4.7 Cl 98 CO2 30 BUN 8
SCr 0.7 Ca 9.5 Mg 2.2 Phos 3.8 Alb 5.0
Hgb 10.1 Hct 30% Plt 320 WBC 7.6
MCV 72 Retic 0.4% Fe 48 FBG 92
Objective: HA
If the patient is positive for H. pylori, a triple drug therapy can be considered which includes Amoxicillin, Clarithromycin, and a PPI

If the EGD shows a gastric ulcer, NSAID ulcer healing treatment should be implemented.
the use of NSAIDs should be reduced as much as possible
If ASA is continued, a PPI can be used for 8-12 weeks and may be used in conjuction with Misoprostol

Patient must be educated on the importance of adherence to her drug regimen and the effect that NSAIDs have on ulcer formation
Assessment: PUD
Assessment: HA
Several types of HAs she can be suffering from
tension (most common)
sinus
cluster

Full transcript