Nsaid Induced Duodenal

ulcer Done By : Aya kamel Ali #1

Subjective :He complains of epigasteric abdominal

pain , vague abdominal discomfort and

dizziness

He noticed darkening of stool one week

ago

the pain come between 1-3 am and

relived by food He describes it of being

moderately to severe

SOAP Note

SOAP Note

Subjective , cont

Endoscopy shows multiple gastric ulcer

Manager of stressful job

His father died at age of 59 of shock due to

severe GI bleeding 2ry to untreated PUD

SOAP Note

Objective :

Hgb 11.0 mg/dL

Hct 33

Abd : Mild tenderness , no masses

Rect : Non-tender ; melenic stool found in

rectal valut ; stool heme +ve

Endoscopy shows multiple gastric ulcer .

Risk factors : Nsaid use (ibuprofen)

Age

Smoking

Family history

Stress

Assessment

DRP

Indication (Needs

additional drug therapy )Untreated condition

A.S 55 year-old African-American male who

suffers from epigastric abdominal pain 1 year

ago which not relieved by using OTC antacid

(Maalox & Bismuth subsalicylate ) needs

additional drug therapy

DRP ,,, cont

Safety (adverse drug

reaction )Undesirable effect

A.S 55 year-old African-American male who

takes OTC bisthmus subsalicylate for

epigasteric abdominal pain , but his condition

become worse and develops bleeding as a

side effect which increase risk of recuurance

. he needs to stop using it .

Therapeutic goal

Short term goal :

Prevent complication (perforation , penetration

, obstruction , malignancy

promote ulcer healing Stop the ulcer bleeding

Symptomatic relive .

Long term goals :

Preventing recurrence and avoiding potential

complications.

Reduce financial cost of treatment .

According to blatchford score

Patient has high risk of

bleeding

Blatchford score

Pharmacological intervention :

Stop using ibuprofen to prevent further

complication

Stop using bismuth subsalicylate to

minimize the risk of bleeding .

Cont …

Add omeprazole 2o mg Bid

Brand name : Gasec by mepha company

Price 27 SR

Alternatives

Ranitidine double dose 300 mg q.i.d

Endoscopy treatment

Non pharmacological

intervention

Omega -3 fatty acids has anti-inflamatory

effect help to protect the stomach from ulcers

Acupuncture treatments .

Endoscopy treatment .

Injection therapy .

Yoga practice to manage stress

Monitoring

Efficacy

Symptomatic improvement.

Safety

The appearance of adverse events like :

muscle cramps, muscle weakness or limp

feeling; seizures

Monitoring

Testing for H.pylori

Patients taking the test should stop taking

PPIs for at least 2 weeks (they interfere with

the test) and starve for 4 hours before.

Fecal Occult Blood Test

CBC & Hemoglobin

Follow up

• Assess the adherence.

• Assess the signs and symptoms of progression of ulcer

Follow up session should be scheduled 2-4 weeks after initiating the therapy.

repeat endoscopy to confirm healing at 6 to 8 weeks.

If ulcer healed decrease omeprazole dose gradually to maintenance dose to prevent recurrence.

Patient education :

Take omeprazole 1 hour before meals .

Avoid spicy food and xanthin containing

beverage and , drinks containing caffeine.

Avoid heavy meals before bed time

Smoking increases the amount of acid

produced by the stomach . need smoking

cessation plan .

Encourage small frequent low caloric meals

Avoid ulcerating drug e.g. NSAIDs

,Corticosteroid.