A Case Scenario: Peptic Ulcer Disease

History:
Patient X, a 59 year-old female patient was seen in the emergency room of Nightingale Hospital
with a chief complaint of severe epigastric pain. According to the patient, the pain started two months
ago however the severity of pain is intolerable after taking aspirin and coffee this morning “Nasakit unay
toy tiyan ko. Diak nga kaya iti sakit nan.” On further assessment the pain scale is at 10/10 with radiation
in the chest to back.
Furthermore, upon history taking the patient is also experiencing nausea, vomiting, bloating and
frequent vomiting. In addition, the patient also reported coffee ground emesis and black and tarry stool,
weight loss and fatigue. The patient was also noted to be pale. “Agkakapsot nak kada kanayun nak nga
agsarwa iti nangisit” as verbalized by the patient.
Initial vital signs were as follow:
BP: 140/80mmHg
HR: 97 bpm
RR: 21 cpm
Temperature: 36.8°C
O2 Saturation: 97%
Height: 167 cm
Weight: 48 kgs
Past Health History:
Patient was diagnosed with gastritis 6 years ago but was resolved with medication. She has been
taking aspirin and NSAID for her previous heart attack and osteoarthritis respectively. Patient has no
surgical history. Her mother died of gastric cancer and her father died of colon cancer. Her brothers are
alive and also have a history of duodenal ulcers. She has a history of smoking, fond of eating spicy foods
and drinking sodas.
Admission diagnosis:
Gastritis vs Peptic Ulcer Disease

February 26, 2021

ER Orders

Doctors Order:

Please admit patient to room of choice under the service of Dr. Solante

Please secure consent for admission

TPR per shift and record

NPO temporarily

Diagnostics:

CBC with platelet

 Whole abdominal ultrasound

BUN and creatinine

Serum electrolytes- K and Na

Please start PLRS IL x 8 hours for two cycles

Start Kabiven x 24 hours

Give HNBB now then PRN for epigastric pain

Give 40 mg omeprazole now then OD in AM

Start metoclopramide 1 ampule IV for N/V

Start ciprofloxacin 200 mg IV q12

Please refer accordingly

Laboratory Result:

CBC

RBC- 2.9 x10 (12)/L (Normal 3.8- 6.5 x 10 (12)/L)

HGB- 98g/L (Normal 120-160 g/L

WBC- 10.2 x 10 (9)/L (Normal 5-10 x10 (9)/L)

Platelet- 371 (Normal 150-450 x10 (9)/ L

Serum Electrolytes

K- 3.0 (Normal 3.5-5.3 mmol/L)

Na- 139 (Normal 135-148 mmol/L)

BUN and Creatinine

BUN- 7.0 (Normal 2.8-7.2 mmol/L)

Creatinine- 89 (Normal 53-97 mmol/L)

Ultrasound

The gastric antrum or duodenal bulb showed marked, diffuse and circumferential wall thickening on TUS
and has lesion on the gastric antrum.
Ward Order:

Doctors Order

Please change current IV to PNSS IL KVO

Please infuse two PRBC properly typed and cross-matched

Give 10 mg IV diphenhydramine and 500mg/tab paracetamol 30 minutes prior to blood transfusion.

Start potassium citrate TID

Please repeat H and H 6 hours post BT

Laboratory result:

HGB- 120 (Normal 120-160 g/L

HCT- 36 % (Normal 37-47%)