GROUP 7

Pamintuan, Adie Kim

Quetua, Francesca Marie
Robles, Ma. Cecilia
Santos, Amalia
Tapaoan, Symphony Jane

CASE 1
(FINALS)

CHIEF COMPLAINT
My stomach has been hurting for the
past weeks. Over the weekend I
noticed my bowel movements were
black and tarry.

PATIENT DEMOGRAPHICS
William Smith
Male
62 years old
Height: 59
Weight: 102kg

HISTORY OF PRESENT
ILLNESS
Intermittent burning epigastric pain for more than 2
months.
Intermittent belching, bloated, weak when walking
and nausea after eating.
Pain in right epigastrium, worse with meals.

HISTORY OF PRESENT
ILLNESS
Black, tarry bowel movements
No PUD or GI bleeding
No anorexia or vomiting

PAST MEDICAL HISTORY

COPD (Chronic Obstructive Pulmonary Disease) x 10
years
DM (Diabetes Mellitus) x 10 years
Osteoarthritis x 15 years (right shoulder)

FAMILY HISTORY

Father died at 55: Acute Myocardial Infarction (MI)

Mother died at 65: Lung Cancer (CA)
3 siblings alive and well

SOCIAL HISTORY
Accountant
Married and has 3 daughters
Smokes cigar occasionally
Drinks beer per week

REVIEW OF SYSTEMS
Unremarkable except for complaints noted above

ALLERGY: Penicillins hives

PHYSICAL EXAMINATION: General Overweight man in moderate
distress
SKIN: Warm and dry
HEENT: PERRLA, EOMI, discs flat, no AV nicking, hemorrhages, or
exudates
CHEST: Bilateral rhonchi, faint wheezes

REVIEW OF SYSTEMS
CARDIOVASCULAR: S1, S2 normal; no MRG
ABDOMEN: Normal bowel sounds and mild epigastric tenderness;
liver size normal; no splenomegaly or masses observed
RECTAL: Nontender,; melenic stool found in rectal vault; stool
heme (+)
EXTENSION: Normal ROM except for restricted right shoulder
movement
NEURO: CN II-XII intact, DTRs 2 + throughout

VITAL SIGNS
BLOOD PRESSURE: 120/62
PULSE: 109
RESPIRATORY RATE:18
TEMPERATURE:37.9

LABORATORY RESULTS
RESULTS
SODIUM 144 meq/l
HEMOGLOBIN 9.2 g/dl
CALCIUM 9.2 mg/dl
POTASSIUM 3.9 meq/l
HEMATOCRIT 26.2%
MAGNESIUM 2.0 meq/l

REMARKS
X

X
X

LABORATORY RESULTS
RESULTS
CHLORIDE 98 meq/l
IRON 49 mcg/dl
PHOSPHORUS 4.0mg/dl
CARBON DIOXIDE

REMARKS
X

LABORATORY RESULTS
RESULTS

REMARKS

ALBUMIN 3.9 g/dL

BLOOD UREA NITROGEN 10 mg/dL

FASTING BLOOD GLUCOSE 154 mg/dL

MEAN CORPUSCULAR VOL 74 mm3

PLATELET 230 X 103 /mm3

RETICULOCYTES 0.3%
SERUM CREATININE 1.1 mg/dL
WHITE BLOOD CELLS 8.4 x 103/mm3

X
X

DIAGNOSTIC PROCEDURES
Endoscopy
6-mm ulcer in the gastric antrum
Peripheral Blood Smear
(+) for Microcytic anemia

ABBREVIATIONS
PUD Peptic Ulcer Disease
GI Gastrointestinal
PERRLA -Pupils Equal, Round, Reactive to Light and Accommodation
EOMI Extra ocular Movements Intact
AV Atriovenous
ROM Range of Motion
CN Cranial Nerve
DTR Deep Tendon Reflex

MEDICATIONS
DRUGS
METFORMIN
(Glucophage)

MOA

INDICATION

Reduce hepatic glucose

through activation of
AMPK

Type II Diabetes

Lactic acidosis,
CHF,
hypoxic/acidotic
states

Irreversible inactivation
of the cyclooxygenase
(COX) enzyme

Reduce fever and relieve

mild to moderate pain
from conditions such as
muscle aches

Stomach upset,
heartburn

Short acting muscarinic

antagonist

Long-term treatment of
reversible
bronchospasm
associated with COPD

urinary tract
infection, upper
respiratory tract
infection, sinusitis,
bronchitis, and
exacerbation of
COPD

500mg PO BID
ASA
(Aspirin EC)
325mg PO once
daily
IPRATROPIUM
MDI
(Atrovent)
2 puffs 4x daily

ADR

MEDICATIONS
DRUG
ALBUTEROL MDI
(Ventolin)
2 puffs PRN
IBUPROFEN
(Advil)

MOA

INDICATION

Short-acting,
selective B2adrenergic receptor
agonist

Asthma and COPD

Acute infection of the

nose, throat, sinus,
fast heartbeat,
feeling of throwing up

Related to (NSAIDs),
prostaglandin
synthetase inhibition

Usedto reduce fever

and treat pain or
inflammation

Hemorrhage,
vomiting,
hypertension,
eosinophilia, and
anemia

Neutralizes gastric
pH

Heartburn, acid
indigestion, sour
stomach, upset
stomach

Nausea, constipation,
diarrhea, headache

200mg 2 tabs PRN

Mg Hydroxide, Al
Hydroxide
(Maalox)
1 tbsp. PRN

ADR

DRUG INTERACTION
Alcohol & metformin
-causes Lactic acidosis
Ibuprofen & Aspirin
- increase your risk of developing gastrointestinal ulcers and bleeding
- may cause severe abdominal pain, bloating, loss of appetite, and/or black,
tarry stools
Albuterol & Magnesium Hydroxide (MAALOX)
- irregular heart rhythm that may be serious and potentially life-threatening:
risk is increased if you have low blood levels of magnesium or potassium

ASSESMENT
PHYSIOLOGY
STOMACH

Breaks down large food particles into smaller pieces

so that they can be processed more easily. It is
intraperitonal and located in the left epigastric regions of
the abdomen.

Hydrochloric acid
-secreted from the parietal cells in the body of the
stomach.

 PATHOPHYSIOLOGY

Peptic ulcer
- is a circumscribed loss of the mucus
membrane of the GIT system exposed
to gastric juices containing acid & pepsin.
Peptic ulcer occur most common in:
-esophagus
-stomach*

Imbalance Of This Factors

Causes Peptic Ulcer Disease:
Aggressive factors
-bile, acid and pepsin
Defensive factors
-mucus, bicarbonates and PG

Other contributory factors:

Helicobacter pylori

NSAIDs

Stress

Ethanol

Tobacco

Complications of PUD
1. Bleeding
- occurs in 25-30% of patients
-most frequent complication and maybe life threatening
-account for 25% of ulcers deaths
2. Perforation
-occurs in about 5% of the patients
-accounts for 2/3 of ulcer deaths
3. Obstruction from edema or scarring

PHARMACOTHERAPHY
Misoprostol
-may be used to prevent gastric ulcers caused by non-steroidal
anti- inflammatory drugs.

Consider that the interaction may be unavoidable if

ibuprofen is administered more than once daily.
Avoid ibuprofen if possible or give it 2 hours after aspirin.
Consider alternative: Acetaminophen* reduces pain and
lowersfevers. Unlike aspirin and other NSAIDS,
acetaminophen is believed to be safe for people with ulcers.

NON-PHARMACOTHERAPY
Refer the patient to a smoking-cessation program
Stress Reduction
Avoidance of dietary irritants (Alcohol)
Physical activitycan help reduce some kinds of
discomfort, such as arthritispain.

REFERENCES
-MEDSCAPE
-WEBMD
-DRUGS.COM
-MEDLINEPLUS MEDICAL ENCYLOPEDIA
-Katzung et.al., Basic and Clinical Pharmacology (p. 355 &757)