Risk Factors Analysis

Problem Theory Patient

PUD Age Age
Male Male
Current smoker Current smoker
Heavy drinker
H. Pylori infection
Reflux esophagitis
Diabetes
NSAID

Lee, S. P., Sung, I. K., Kim, J. H., Lee, S. Y., Park, H. S., & Shim, C. S. (2016). Risk Factors
for the Presence of Symptoms in Peptic Ulcer Disease. Clinical endoscopy, 50(6), 578–
584. doi:10.5946/ce.2016.129
 Risk
RISK FactorsANALYSIS
FACTOR Analysis
PROBLEM THEORY FACTUAL
Risk Factor of Heart Failure

• Coronary artery disease

• Past heart attack (myocardial infarction)
• High blood pressure (hypertension or HBP) 
• Abnormal heart valves 
• Heart muscle disease (dilated cardiomyopathy,
hypertrophic cardiomyopathy) or inflammation
(myocarditis)
• Heart defects present at birth (congenital heart
disease)
• Severe lung disease
On This Patient
• Diabetes
HF st. C fc. III • Coronary artery
• Obesity
disease
• Sleep Apnea

Other conditions
• Low red blood cell count (severe anemia)
• An overactive thyroid gland (hyperthyroidism)
• Abnormal heart rhythm (arrhythmia or
dysrhythmia)

American Heart Association

 Key Message Pathophysiology (PUD)

• Peptic ulcers are defects in the gastric or duodenal

mucosa that extend through the muscularis
mucosa.
• The epithelial cells of the stomach and duodenum
secrete mucus in response to irritation of the
epithelial lining and as a result of cholinergic
stimulation.
• The superficial portion of the gastric and duodenal
mucosa exists in the form of a gel layer, which is
impermeable to acid and pepsin.
Anand, 2018.
Medscape
 Key Message
Key messages Pathophysiology (HF)
Pathophysiology
 Key Message Diagnosis (PUD)

• Epigastric pain is the most common symptom of

both gastric and duodenal ulcers.
• It is characterized by a gnawing or burning
sensation and occurs after meals—classically,
shortly after meals with gastric ulcer and 2-3 hours
afterward with duodenal ulcer.
• Food or antacids relieve the pain of duodenal ulcers
but provide minimal relief of gastric ulcer pain.

Anand, 2018.
Medscape
 Key Message Diagnosis (PUD)

• Duodenal ulcer pain often awakens the patient at night.

• About 50-80% of patients with duodenal ulcers
experience nightly pain, as opposed to only 30-40% of
patients with gastric ulcers and 20-40% of patients with
nonulcer dyspepsia (NUD).
• Pain typically follows a daily pattern specific to the
patient.
• Pain with radiation to the back is suggestive of a
posterior penetrating gastric ulcer complicated by
pancreatitis.

Anand, 2018.
Medscape
Key Message Diagnosis (HF)
 Management Analysis

Problem Theory Patient

PUD • Evaluate complete blood • IVFD Wida KN2 500 cc
cell for 3 hours – 2 cycles
• Evaluate BUN and
creatinine levels for fluid  equal fluid balance
resuscitation  IVFD NaCl 0.9%
• Type and screen and 1500 cc for 24 hours
crossmatched blood for • IV lansoprazole 1 x 30
transfusion is indicated in mg
unstable or potentially
critical patients.
• Evaluate hemostatic
profile if there is bleeding
condition
• Evaluate amylase, lipase
to rule out diagnosis
• H. pylori screening
• PPI
 Management Analysis
MANAGEMENT ANALYSIS
PROBLEM THEORY FACTUAL

Management of Heart Failure

• The need to perform thorax rontgent,

echocardiography, and BNP
• Oral Diuretic or Parenteral Diuretic is the
main treatment in patient with heart failure On this patient :
• Low dose ACE inhibitor or ARB may
begun when the patient euvolemic - Bed rest,
• Low dose beta blocker until optimal dose semifowler position
of beta blocker can begun after diuretic - Low salt diet < 2
Heart Failure and ACEi or ARB given to the patient gram/ day
• Digitalis could be given if there is any - PO Ramipril 1 x 5
supraventricular aritmia (AF or SVT) or the mg
3 drugs above can’t give the satisfied result. - PO Spironolacton 1
x 25 mg
PAPDI
 Key Message Management PUD

• Workup will vary depending on presentation and includes the following:

• Complete blood cell (CBC) count is used to evaluate acute or chronic blood loss.
• Electrolytes, blood urea nitrogen (BUN), and creatinine levels are useful tests for
critical-appearing patients who require fluid resuscitation.
• Type and screen and crossmatched blood for transfusion is indicated in unstable or
potentially critical patients.
• Activated partial thromboplastin time (aPTT), prothrombin time (PT) and
international normalized ratio (INR) are indicated in patients with active bleeding and
those on anticoagulants.
• Amylase, lipase, and liver transaminase levels can be helpful to rule out other
common causes of epigastric pain.
• Patients younger than 55 years with no alarm features should be referred for
noninvasive testing for H pylori infection in the outpatient setting
• Proton pump inhibitors are potent inhibitors of the proton (acid) pump (ie, the
enzyme H+,K+-ATPase), located in the apical secretory membrane of the gastric acid
secretory cells (parietal cell). Proton pump inhibitors can completely inhibit acid
secretion and have a long duration of action.

Anand, 2018.
Medscape
Key Message Management HF
 Key Message Social

• Patient need to be educated if there is alarm features

that warrant prompt gastroenterology referral include
the following:
• Bleeding or anemia
• Early satiety
• Unexplained weight loss
• Progressive dysphagia or odynophagia
• Recurrent vomiting
• Family history of gastrointestinal cancer
• Stress reduction counseling might be helpful in
individual cases but is not needed routinely.
Anand, 2018.
Medscape
 Key Message Social

• Patient with heart failure are likely have many risk

factors, such as diabetes mellitus and hypertension
• Patient with heart failure should be monitored for
the compliance for taking the drugs