Peptic Ulcer Disease

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍heartburn

Symptoms include:

‍epigastric pain

‍heartburn

‍bloating

‍fullness

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍dark, tarry stools

‍unexplained weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍dyspepsia

‍belching

‍acid reflux

‍loss of appetite



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍smoking

‍high alcohol consumption

‍poor diet

‍stress

no history of: ‍peptic ulcer, ‍H.pylori infection

no use of: ‍NSAID, ‍antiplatelet, ‍anticoagulants





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍





ASSESSMENT:

‍Peptic Ulcer Disease ‍likelysuspectedpossible

DDx: peptic ulcer disease, GERD, gastritis, gastric ulcer, duodenal ulcer, stress ulcer, H. pylori infection, NSAID-induced ulcer, Zollinger-Ellison syndrome, gastric cancer, esophagitis, pancreatitis, gallstones, cholecystitis, inflammatory bowel disease, irritable bowel syndrome, celiac disease, intestinal ischemia, gastrointestinal bleeding, lactose intolerance, food allergy/intolerance, gastroenteritis, myocardial infarction





PLAN:

Investigations:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍LFTs, ‍lipase, ‍amylase, ‍H. pylori antibodies

- Stool test for H. pylori

- Breath test for H. pylori

- Upper GI endoscopy

- Abdominal ultrasound

Treatments:

- ‍PPIs

- ‍H2 blockers

- ‍Other antacids

- ‍H. pylori treatment

- Avoid NSAIDs

- Dietary modifications: ‍avoid spicy foods, ‍avoid alcohol, ‍avoid caffeine, ‍avoid acidic foods, ‍avoid fatty foods, ‍avoid carbonated beverages, ‍avoid dairy products

- Smoking cessation counseling

Further care:

- Referral to gastroenterologist

- Follow-up in ‍ ‍daysweeksmonths

- Return if symptoms worsen or if new symptoms develop such as vomiting, weight loss, or black stools