INTRODUCTION OF THE CASE

The purpose of the case is to study about gastric ulser. gastric ulser is an epidemic disease in
Malaysia. Gastric ulcers are usually caused by Helicobacter pylori (H. pylori) bacteria or non-
steroidal anti-inflammatory drugs (NSAIDs). These can break down the stomach's defence
against the acid it produces to digest food. Gastric ulcers tend to occur later in life, after age 60,
and affect women more often than men.

STATISTIC OF CASE:

WORLWIDE:

Gastric ulcer affects four million people worldwide annually and has an estimated lifetime
prevalence of 5−10% in the general population . Although the global prevalence of Gastric ulser
has dramatically decreased in the past decades , the incidence of its complications has
remained constant .

MALAYSIA:

The overall H. pylori infection prevalence rate was unusually low at 13.5% (54 of 400) in this
region. The prevalence among the races were as follows: Malay 6.6% (17/256), Chinese 24.1%
(27/112) and Indian 28.6% (6/21). Gender and age were not significant associated factors for H.

The highest affected age is 60-69 years old

COMPLETE HEALTH HISTORY

BIOGRAFIC DATA:

R/N AM00839491

NAME LEONARD WINSTON TAN TZIN QHENG

DATE OF BIRTH 13/08/1986

AGE 37 YEARS OLD

GENDER MALE

RACE CHINESE

RELIGION BUDDHA

ADRESS NO. 23 JALAN PUTRA PERMAI 10/15 PUTRA

HEIGHT 46500 SUBANG JAYA

DATE ABMISSIONS (DOA) 13/07/2023 @ 6.30 A.M.

NEXT OF KIN RACHEL (WIFE)

NEXT OF KIN PHONE NUMBER 0139466317

CHIEF COMPLAINT:

-Generalised abdominal pain since 3 days ago on 6am (colicky in nature)

-Unable to BO and pass flatus since yesterday

-Reduce oral intake since yesterday

Otherwise,

no fever/other infective sing and symptom (sx)

no chest pain

no shortness of breath (SOB)

no vomiiting
PRESENTING SYMPTOMPS

1. Patient complaint pain at right and left upper quadrants of the hypochondrium score 7/10
from 3 days ago

2. patient complaint unable to BO since yesterday and the last stool was watery and black

3. Reduce oral intake because patient loss appetite

FAMILY HEALTH HISTORY

dennies family history malignancy

PAST MEDICAL HISTORY:

no know medical illness (NKMI)

PAST SURGERY HISTORY:

no history of surgical

SOCIAL HISTORY:

chronic smoker nore then 20 years old (1 pack/day)

festive alcohol drinker

denies high risk behaviour/ multiple sexual partners

ALLERGIC:

No known food and drug allergieS (NKFDA)

PHYSICAL EXAMINATION

VITAL SIGN:

BLOOD PRESSURE 116/64

TEMPERATURE ( C ) 36.7

SPO2 (%) 99 ( UNDER ROOM AIR)

RESPIRATION RATE 20

PULSE RATE 102

PAIN SCORE 7/10

REVIEW OF SYSTEM

CARDIOVASCULAR:

-INPECTION: no scar, no abnormal movement, no chest deformity,apex beat was normal

-PALPATION: apex beat palpable at 5th intercostal space

-PERCUSSION: no cardiac dullness

-AUSCULTATION: dual rhythm no murmur (DRMM)

RESPIRATORY:

-Equal air entry

- Inspection:No scar , the shape of chest is symmetrical

-Palpation:Soft and tender over left iliac fossa,no rigidity

- Percussion: No resonance and dullness detected

- Auscultation:No wheeezing,No rhonci, No whooping sound detected

ABDOMINAL

-INSPECTION: no scar

-PALPATION: tender on right and left upper quadrant,

-PERCUSSION: no dullness

-AUSCULTATION: heard rapid bowel sound and movement

FOCUS REVIEW:
Pain and tenderness at abdominal region especially at riaght and left upper quadrant

AREA OF COMPLAINT:
REVIEW LAB:

FULL BLOOD COUNT (FBC)

RESULTS/DATE 19/7 20/7 21/7 22/7

HEMOGLOBIN 9.5 9.7 9.6 9.6

(HB) g/L

HEMATOCRIT 29.6 30.6 28.5 29.8

(HCT) %

PLATELET 10/L 584 670 728 843

WHITE BLOOD 19.8 18.8 19.3 19.9

CELL (WBC) 10/L

ARTERIAL BLOOD GAS

Ph 7.47

PCO2 (mmHg) 37

PO2 (mmHg) 148

SPO2 (%) 99

HC03 (mEq/L) 26.9

BASE EXCESS (BE) 3.2

RENAL PROFILES & SERUM ELECTROLYTES :

TEST/DATE 19/7 20/7

UREA (mmol/L) 2.5 2.3

SODIUM/NA (mmol/L) 136 135

POTASSIUM/K (mmol/L) 3.6 4.5

CHLORIDE (mmol/L) 106 107

SE CREATININE (umol/L) 49 49
DISEASE PROCESS

DEFINITION:

Gastric ulcer is is a break in the inner lining of the stomach, the first part of the small intestine,
or sometimes the lower esophagus. An ulcer in the stomach is called a gastric ulcer, while one
in the first part of the intestines is a duodenal ulcer. Gastric ulser is a medical emergency, and if
left untreated, the ambdominal wall may have perforated gastric ulcer.

CAUSES:

- infection with bacteria called Helicobacter pylori, or H. pylori.

-smoking

PATHOPHYSIOLOGY:

Gastric ulcers are a break in the mucosa of the stomach lining that penetrates through the
muscularis mucosa and extends more than 5 mm in diameter. When alterations occur to the
defense mechanisms of the stomach, it can cause changes in the gastric mucosa which will
eventually result in erosion and then ulceration.
CLINICAL MANIFESTATION

-Abdominal pain at left and right upper quadrant

-Fatigue

-Pale skin

-Fatty food intolerance

TREATMENT AND MANAGEMENT:

--IV CEFOBIB 2G

-IV FLAGYL 500my stst

-IV TRAMADOL 50mg TDS

-IV FENTANYL 25mcg stat/PRN

-IV PENTROPRAZOLE 40mg BD

-IVD 4PINTS (2 NORMAL SALINE/ 2DEXTROSE 5%)

-GIVE OXYGEN 3L/MIN NASAL PRONG

-INSERT RYLES TUBE

-INSERT CBD

-KEEP NEIL BY MOUTH (KNBM0 WITH IVD

-MONITOR I/O CHART

-MONITOR VITAL SIGN

-BLOOD TRANFUSION
HEALTH EDUCATION:

1.Wash hand with soap regularly using the 8 step in hand washing.

2. Maintain a clean environment.

3. Provide wound care regularly to avoid any complication after operative.

4. Eat healthy and the balanced diet to help in production of antibodies and

digestion.

5. Avoid any strenuous activities such as bicycle,running or weight lifting.

6. Always monitor the colour of the incision area or drainage to avoid any

inflammation after operative.

7. Eat the prescription medicine with the right dose and at the right time.

NURSING CARE:

1) Monitor vital sign every 4 hours in the ward after admission.

2) Monitor vital sign every 15 minutes after post operative,hourly,and and every 4

hours.

3) Check glucose when patient is in keep nil by mouth (KNBM) to avoid hyperglycemia or

hypoglycemia.

4) Monitor input and output chart.

5) Insert ivd for normal saline and 5%dextrose

6) Put catheter bladder drainage (CBD) to avoid patient going to the toilet when

complete rest in bed (CRIB) or rest in bed (RIB).

7) Nil by mouth (NBM) with IVD with 4 pints 2NS,2D5% for 24 hours.

8) ECG to check heart activity before going to the surgery.

9) Rest in bed in ward after the surgery.

10) Make sure all consent have been been filled before the surgery.
11) Make sure to change the dressing daily and educate the patient and family

member about hygiene at the surgery area.

12) Monitor and fill the drain chart to avoid any unusual drainage.

13) Give iv augmentin 1.2g STAT and TDS for antibiotics.

14) Give iv tramal 50mg TDS for pain reliever.

15) Give tab paracetamol 1g QID for fever .

16) Give bisacodyl suppository can increase activity of the intestines to cause a bowel

movement to empty the bowel before the surgery.

COMPLICATION:

-Peritonitis

-Internal bleeding

-Perforated gastric ulcer

-Obstruction

-Gastric cancer

-Trauma

-Postoperative wound infection

PROGNOSIS:

Good with early detection and get early treatment at the hospital.
OBJECTIVE AND RATIONALE OF TREATMENT

TREATMENT RATIONALE

EAT ANTIBIOTIC TO FIGHT THE INFECTION

AGAINTS THE BACTERIA

LAPAROTOMY TO EXAMINE THE

ABDOMINAL ORGANS AND
AID DIAGNOSIS OF ANY
PROBLEMS

DRESSING AVOID WOUND INFECTION

COMPLETE REST IN BED TO REDUCE PATIENT

MOVEMENT

KEEP NIL BY MOUTH (KNBM TO EMPTY STOMACH,

REDUCE RISK WHEN
OPERATION

MONITORING VITAL SIGN TO KNOWN CONDITION OF

PATIENT

GIVE HEALTH EDUCATION TO MAKE SURE PATIENT AND

RELATIVE MAINTAIN GOOD
HYDRATION, HYGIENE AND
GET MEDICAL CHECK UP
REFERENCES:

- https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-
20354223

- https://en.m.wikipedia.org/wiki/Peptic_ulcer_disease

- https://www.ncbi.nlm.nih.gov/books/NBK420/

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/laparotomy#:~:text=A%2
0laparotomy%20is%20a%20surgical,tissue%20within%20the%20abdominal%20cavity.

- https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-
tract/stomach-
ulcer#:~:text=Stomach%20ulcers%20are%20usually%20caused,causing%20an%20ulcer%20to%
20form.
 CASE STUDY:

GASTRIC ULCER

NAME: ANIS IZZATI BINTI MOHAMED SALLEHUDIN

MATRIC NUMBER: DMA09210002

COHORT/INTAKE: COHORT 28 INTAKE SEPTEMBER 2021

CLINICAL PLACEMENT & LOCATION: HOSPITAL AMPANG- WAD SURGICAL 5D

DURATION OF PLACEMENT: 3/7/2023-28/7/2023

DATE OF SUBMISSION: 27/8/2023

NAME OF CLINICAL INSPECTION: NORIDAH MAZLAN