Real-Life Challenge: Ulcers
A 50-year-old man is experiencing midepigastric pain and heartburn along with nausea and vomiting, with the onset approximately 1 week ago. The patient says that the pain is better after eating and more severe 2 hours after eating. The patient is observed sitting slightly bent over with knees drawn up. Vital signs are temperature, 99.88° F; pulse, 104; respirations, 24; and blood pressure, 136/88. His skin is warm, dry, and pale. The physician suspects a duodenal ulcer. The abdomen is slightly distended and tender to palpation. Diagnostic investigation includes Hgb, HCT, gastric analysis, stool exam for occult blood, upper GI series, and a gastroscopy. Drug therapy includes antacid, histamine (H2) blockers, and an antibiotic. The patient is instructed to adhere to a bland diet, including small and more frequent meals.
1. What population is most prone to develop ulcers?
2. Compare gastric, duodenal, and peptic ulcers.
3. Why would symptoms of gastric and duodenal ulcers vary?
4. Discuss theories of the cause of ulcers. Compare theories of ulcerogenic drugs versus bacterial origin.
5. What warnings should be given to patients taking NSAIDs?
6. Explain the complications of perforation.
7. Discuss the various forms of drug therapy available to treat ulcers.
8. What side effects might a patient on histamine (H2) blockers experience?
9. What would a positive guaiac test indicate?