Question

A. Mike is 46 years old who presents with a complaint of "heartbun" for the past 3 months. He describes the pain as burning and located in the epigastric area. The pain improves after he takes an antacid or drinks milk. He has been taking either over-the-counter famotidine or ranitidine off and on for the past 2 months and he still has recuring epigastric pain. He has lost 6 pounds since his last visit. He is a nonsmoker. His examination is unremarkable. His blood pressure is 118/72 mm Hg. Laboratory values are normal (including CBC) and his serum H. pylori test is positive. 1. What is the plan of care for Mike? 2. What education does he need?

please guve patho of the disease, drug of choice and dosage!

Answer 1

Mike has peptic ulcer as his H. Pylori test is positive ,due to which he has heartburn and pain in the epigastric area .

Peptic ulcer is an excavation formed in the mucosal wall of the stomach ,pylorus ,duodenum or esophagus . It is frequently referred to as a gastric , duodenal or esophageal ulcer depending on its location .

# Etiology of PUD

- NSAIDs ( main cause )

-H. pylori

-Stress

-Alcohol abuse

-Excessive caffeine

-Smoking

-Genetic susceptibility

# Two major mechanism of pathogenesis are :-

- duodenal

- acid and

# How can NSAIDs cause PUD

-They counteract prostaglandin E secretion which is the major STIMULANT of GASTRIC MUCUS PRODUCTION

-They diminish the protective layer of stomach

-People have a high risk of ulcer when NSAIDs are used & H.pylori is present

# Symptoms

-Epigastric, abdominal pain

-Episodes of pain occur between meals, about 2 to 3 hours after eating

-Pain is intense; a burning and gnawing sensation is present that can be slightly relieved by food and can be strong enough to awaken a person from sleep.

-Perforation of the stomach or intestinal wall leads to sudden, excruciating abdominal pain, abdominal rigidity, pale skin, hematemesis, and cold sweat

# Treatment ( plan of care)

-Antibiotics combined with proton pump inhibitors and bismuth salts to suppress H.pylori

-Antacids in combination with cimetidine or ranitidine for treatment of stress ulcers

-Histamine 2 antagonists

-PPI (proton pump inhibitors )

-Lifestyle changes ( health education on the following points ):-

1. Stress reduction

2. Rest

3. Smoking cessation

4. Dietary modification

# Surgery - with the invention of H2 receptor antagonist , surgical interventions is less common . If recommended ,surgery is usually for intractable ulcers , life threatening hemmoragh , perforation or obstruction . Surgical procedures include vagotomy , vagotomy with pyloroplasty or Billroth I or II.