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peptic ulcer disease.docx

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Health Science
HLSC 2461U
Otto Sanchez

Peptic Ulcer Disease 58 year old male complaining of 3-week history of increasing epigastric pain Has had dyspepsia in the past for which he took Tums, but this is much worse and only partially relieved with chewable antacids  Epigastric pain can be confused with the angina or heart attack. Even in the stomach we talked in cardiovascular 1 and 2 how esophagitis, hepatitis and all that can cause pain  GI disorders tend to produce very vain symptoms. Even people with appendicitis can show up with epigastric pain  Dyspepsia – heart burn  The pain for point 2 and point 1 are very different. Sometimes people complain about heart burns and they tend to be dismissed. Dyspepsia can be cardiovascular or GI – esophagus, stomach, duodenum, liver, transversal colon even respiratory: most lung disease don’t hurt and when they hurt its when they reach the pleural and that is pleuritic pain – the pain changes when you breathe and they say yes is most likely pleuritic pain or injury to the thoracic wall. Pain has a burning quality Relieved when eating, especially drinking milk, but recurs about 2 hours later Denies radiation to his back, melena, hematemesis or fever Denies early satiety, anorexia or weight loss Denies fatty food intolerance or change in stools Denies jaundice, increasing abdominal girth, or easy bruising Denies shortness of breath or pain with exercise  If the guy is having a heart attack?? No shortness of breath or exercise – this decreases possibility of CV  Burning quality can help because it implies – because to burn you need to have pain receptors and the stomach doesn’t have pain receptors but the esophagus has especially the upper 3 – the burning quality indicated that whatever happens affects the esophagus the most common symptom is heart burn or GERD. So this tells you there’s rd reflux but that reflux is reaching the upper 3 of the esophagus and that’s what causes the burning quality of the pain so guy has reflex. The problem is if its chronic can cause disease esophagitis, damage to the sphincter gastro esophageal sphincter, inflammation. If the reflux is chronic can damage the function of the sphincter and then it makes the reflux more chronic and severe. Also hiatal hernias and there are the ones when the cardiac (between stomach and esophagus) gets displaced and the sphincter doesn’t work as well.  Radiation to his back of the pain – referred pain and its one condition that very commonly causes epigastric pain at the same time very severe gastric pain – pancreatitis (inflammation of the pancreas) pancreatitis many times it mimics heart attack and can lead to shock and peritonitis.  Melena and hematemesis – severe upper GI bleeding. Tells you maybe he has only gastritis and if he has an ulcer is most likely a gastric ulcer. Because if it was duodenal he would throw up blood.  Weight loss very important because of cancer. Anyone with all these symptoms can have gastric cancer so consider weight loss and another silent killer is the cancer of the esophagus because there are many men after 50 that have it. Cancer if the esophagus is clinically very silent it doesn’t cause any bleeding or anything just weight loss so think about it.  Fatty food intolerance – lecture. Fatty foods to be absorbed they need liver and pancreas. Liver prod bile which emulsifies the fat and pancreas because the pancreas prod lipases which breaks down the lipids. If the guy denies change in stools or fat absorption then you can say the liver and pancreas are fine  Jaundice (many cues) – very important manifestation of liver disease especially when cirrhosis and pancreatic disease jaundice most common symptom of pancreatic cancer. If he tells you he has jaundice you immediately think pancreatic cancer. Jaundice can indicate pancreatic disease, liver disease, hemolytic disease.  Easy bruising and liver disease – whenever the liver prod coagulation factors when a person has liver disease they won’t produce coagulation factors so no fibrin, fibrinogen and all the coagulating things look it up  Increase abdominal girth – ascites so the second last point shows you he doesn’t have any liver failure or cirrhosis Has been taking ibuprofen for the past 2 months for a sore knee Drinks approximately 3 mixed drinks each day Smokes 1 pack of cigarettes a day Has had recent job change with a great deal of stress Has been feeling a little tired lately but no recent illness or hospitalization Has a history of mild hypertension treated with diet  No medications or known allergies Ulcers:  Which one of these are important factors for ulcers?  He drinks 3 times a day that’s a risk factor for acute gastritis, chro
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