Case Study, Chapter 46, Management of Patients with

Gastric and Duodenal Disorders

1. Ms. George is a 32-year-old computer programmer. Over the last several

months, she has had increased episodes of a burning sensation in the mid
epigastrium and back. The pain subsides after eating. Based on her history,
the physician orders an endoscopy that reveals several peptic ulcers.
Treatment of the ulcers includes antibiotics, proton pump inhibitors, and
bismuth salts.

a. Correlate Ms. George’s clinical presentation to the pathophysiology of

peptic ulcers.

a. Stress situations like anxiety anger frustrations etc. cause the

increase in HCL secretion and produce stress ulcers.

b. Malnutrition, smoking, irregular meal habits, spicy and caffeine rich

foods, impaired mucosal blood flow etc. produce ulcers.

c. Most common sites are lower end of esophagus, lesser curvature of

stomach and first part of duodenum. That’s why peptic ulcer causes
burning sensation in epigastrium.

d. She has ulcers mainly on duodenum and it’s called duodenal ulcers.
It has increased appetite and pain relieved by food intake.

b. Ms. George asks why eating decreases her pain; how does the nurse
respond?

Peptic ulcers include gastric ulcer and duodenal ulcer. Gastric ulcer, in
which pain aggravate on taking food. But here the patient has
duodenal ulcers and here pain is relieved by taking food. It’s called
“Hunger “pain.

c. Explain the rationale for the prescribed pharmacologic therapy.

a. Antibiotics: The major cause for ulcers are Helicobacter pylori

infection. Antibiotics such as amoxicillin, tetracycline are given to
eradicate these bacteria.

b. Proton Pump inhibitors: Inhibit parietal cell which secrete hcl. They
stop acid secretion completely by inhibiting Hydrogen pump.

c. Bismuth: Colloid bismuth sulphate is a good drug for ulcer. Also

used in H. Pylori eradication.