Progressive Case Analysis

PEPTIC ULCER DISEASE (PUD)

Yolanda Ulysses*, a 37-year old widow, single mother of 4, works as a dishwasher for half a
decade in an eatery in Paoay, Ilocos Norte was rushed and admitted at the Medical
Department of Mariano Marcos Memorial Hospital and medical Center due to temporary loss
of consciousness, complains of passage of black -tarry stools for almost 3 days and almost
“unbearable pain” after meal for the past 2 days which she self-medicated with her preferred
pain killer of choice (Alaxan FR(Ibuprofen+ Paracetamol)) and professes of slight temporary
relief. In addition, that she frequently uses the aforementioned medication to alleviate body
pains due to the nature of her hard labor. The mentioned signs and symptoms with weakness
and grave paleness was noticed by her boss and was advised to seek medical consultation,
however due to monetary constraints being the breadwinner of the family, she ignored her
boss’ directive.
Furthermore, she affirms that two years ago, she consulted the Rural Health Unit in the stated
locality because of dyspepsia, heart burn, abdominal discomfort and she took prescribed
medication involving a cocktail of antibiotics and antacids, which she could not recall the names.
She asseverates that during that time being, the doctor explained to her, that she had a
stomach infection however due to monetary fiasco and the dramatic feeling of relief she did
not finish the course of medications.
She was admitted today @ 07:00am with a diagnosis of Upper Gastrointestinal Bleeding
secondary to (Bleeding) Peptic Ulcer Disease.
Physical Examination results:
• looked pale and afebrile.
• VS: HR- 102/min BP- 90/60 mmHg RR-21/min
• no clubbing, lymphadenopathy and skin lesion.
• Height: 153 cm/5’1’’ (at 50th percentile reference value of CDC)
• weight was 43kg (<3rd Percentile of reference value of CDC)
• Rigid, hard abdomen, tender to touch in epigastrium with noticeable guarding behavior on
the area, globularly enlarged,
Auscultation: bowel sounds 10 per min. normoactive
Percussion: Resonant
• No abnormality was noted in the perianal region
• no signs of inflammation in any joints
• other systemic examination revealed no abnormality.
DRE: no palpable mass, smooth rectal wall and black tarry stool on examining finger
Laboratory results:
• Hb-8.2 g/dl
 RBC 3.5 million cells/mcl
 HCT: 28.8 %
• WBC 12,000x 103/cu mm with neutrophilia (74%),
• ESR was 69 mm in 1st hr
 Fecal Test:
Color: Black
Consistency: Soft
RBC: TNTC
FOBT: Positive
 Urea Breath Test: Active H. Pylori Infection
 ABO Typing: 0+
 PT an PTT
Visualizations:
Endoscopy:
Gastric ulcers appear as discrete mucosal lesions with a punched-out smooth ulcer base,
which often is filled with whitish fibrinoid exudate at fundus/antrum.
Radiography:
Unremarkable abdominal x-ray.
MANAGEMENT:
Pharmacological:
Omeprazole 20 mg BID per Orem 10-14 days. Before meals and hour sleep
Amoxicillin 500 mg per orem 2 caps BID for 10-14 days
Clarithromycin 500 mg 1 tab BID for 10-14 days
Hyoscine N-Butyl Bromide (HNBB) 20 mg/1 ml, 1 ml IV now and q 8 ° / PRN for gastric
colic
Tranexamic Acid 500 mg IV q 8 hours
Sucralfate 1 gram 1 tab qid
Other Medical Management:
IVF:
PNSS 1 liter to run for 8 hours
NGT French 16 connect to bed side bottle and monitor output,
I and O monitoring
Stool charting and record frequency and characteristics

Sanguine Management:
Blood: secure 2 units PRBC properly typed and crossed match to run for 4 hours with 1
hour interval Repeat CBC 6 hours post transfusion.
Diet: NPO except oral meds
*Fictional name created by the author for this Scenario.