Expert answer:Peptic Ulcer Case Study

Answer & Explanation:!PYC-614 WS7 Case Study-Peptic Ulcer Disease_May, 2014.docx Please answer case study questions in attached document. Bullet point if fine.
_pyc_614_ws7_case_study_peptic_ulcer_disease_may__2014.docx

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CASE STUDY: PEPTIC ULCER DISEASE
INITIAL HISTORY:
➢ 58 year old male complaining of 3 week history of increasing epigastric pain
➢ Has had dyspepsia in past and took “Tums” but this is much worse and only partially
relieved by chewable antacids
Question 1: What is your differential diagnosis based on this limited history?
Question 2: What questions would you like to ask this patient about his symptoms?
ADDITIONAL HISTORY:
➢ Pain has a burning quality and is relieved with eating, especially drinking milk, but
returns about 2 hours after eating
➢ Denies radiation of pain to back, melena, hematemesis, or fever
➢ Denies early satiety, anorexia, or weight loss
➢ Denies fatty food intolerance or change in stools
➢ Denies jaundice, increased abdominal girth, or easy bruising
➢ No shortness of breath or pain with exercise
Question 3: What questions would you like to ask about his recent and past medical history?
MORE HISTORY AND PHYSICAL EXAMINATION:
➢ Has been taking ibuprofen for 2 months for a knee injury
➢ Drinks approximately 3 mixed drinks a day and smokes 1 pack of cigarettes a day
➢ Has had a recent job change with increased stress and feels tired lately
➢ No recent history of illness or hospitalization
➢ Has a history of mild hypertension that is treated with diet
➢ On no prescription medications and has no known allergies
➢ Thin white male in no acute distress
➢ T = 37 C orally; P = 90; RR = 16 and unlabored; B/P 148/96 right arm (sitting)
HEENT, Neck:
➢ PERRLA, fundi without vascular changes
➢ Pharynx clear
➢ No thyromegaly
➢ No bruits or adenopathy
Lungs, cardiac:
➢ Lungs clear to auscultation and percussion
➢ Cardiac with RRR with no murmurs or gallops
Abdomen:
➢ Abdomen not distended, bowel sounds present
➢ Liver percusses to 8 cm at midclavicular line, one fingerbreadth below right costal
margin
➢ Epigastric tenderness without rebound or guarding and spleen is not palpable
Rectal:
➢ No hemorrhoids seen or felt
➢ Prostate is soft and not enlarged
➢ Stool grossly normal but weakly positive for blood
Extremities, Neurological:
➢ No edema and pulses full with no bruits
➢ Oriented X 4 with normal strength, sensation, and DTR
Question 4: What are the pertinent positives and negatives on the physical exam?
Question 5: What initial diagnostic tests would you obtain?
LABORATORY RESULTS:
➢ Chemistries including calcium and BUN and Creatinine are normal
➢ WBC = 9000 with normal differential and HCT is 45%
➢ Liver function tests including bilirubin are normal
➢ Serum and urine amylase and lipase are normal
➢ EKG shows normal sinus rhythm without evidence of ischemic changes
Question 6: What test should be chosen to best evaluate for peptic ulcer disease in this
patient?
ENDOSCOPY RESULTS:
➢ Normal esophageal mucosa
➢ Gastric mucosa with superficial gastritis and no ulceration
➢ 0.5 cm duodenal ulcer with evidence of recent bleeding but no acute hemorrhage and no
visible vessels in the ulcer crater and H. Pylori testing is positive
Question 7: What management would you recommend?
Brashers, V. L. (2006). Clinical applications of pathophysiology: An evidence-based
approach. St. Louis, MO: Mosby.
…
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