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Thread: [Gastroenterology] 1st Case of Peptic Ulcer Disease

  1. #1

    Default [Gastroenterology] 1st Case of Peptic Ulcer Disease

    R.L. is an otherwise healthy 45-year-old man who works in a high-stress job as an air traffic controller at a major airport. He complains of a 2-week history of “burning stomach pain” sometimes accompanied by “indigestion and bloating.” The pain initially occurred several times a day, usually between meals, and sometimes awakened him at night, but it has increased in frequency during the last week.

    Initially, the pain was temporarily reduced by food or antacids. Last week, R.L. tried an OTC H2 receptor antagonist that “lasted longer” but did not provide adequate symptom relief. R.L. states that he experienced a similar type of pain about 12 years ago when he was treated with omeprazole for a suspected peptic ulcer. He has smoked one pack of cigarettes daily for the past 20 years, has an occasional glass of red wine with dinner, and usually drinks 4 to 6 cups of caffeinated coffee throughout the day.

    R.L. takes acetaminophen when needed for occasional headaches and a daily multivitamin but denies the use of any other OTC or prescription medications, including NSAIDs and the previous use of clarithromycin or metronidazole. He denies nausea, vomiting, anorexia, weight loss, and changes in stool consistency or color. A review of other body systems is noncontributory. He has no known food or drug allergies.

    Physical examination is normal except for epigastric ten- derness on palpation of the upper abdomen. Vital signs include a temperature of 98.8◦F, blood pressure of 132/80 mm Hg, and a heart rate of 78 beats/minute.

    Pertinent laboratory values include the following:
    Hgb, 14.0 g/dL
    Hct, 44%
    Stool guaiac test, negative
    All other laboratory values are within normal limits.
    Clinical Pharmacy Specialist - Hematology

  2. #2

    Default What signs and symptoms are suggestive of a recurrent peptic ulcer?

    Epigastric pain
    Clinical Pharmacy Specialist - Hematology

  3. #3

    Default

    R.L. underwent EGD, which revealed a single 0.5-cm ulcer in the duodenal bulb. The ulcer base was clear without evidence of active bleeding. Astral gastritis was biopsy positive for H. pylori.

    What risk factors may have contributed to ulcer recurrence in this patient?

    Answer:

    Cigarette smoking
    Psychological stress
    Clinical Pharmacy Specialist - Hematology

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