23 January 2024 01:10

Peptic Ulcer Surgery Case Presentation

• Patient Information:

• Name: Mr. Gaurav Dabholkar

• Age: 48 years
• Gender: Male
• Occupation: Shop owner/ Businessman
• Address: Kanakavali

• Presenting Complaint:
Mr. Gaurav Dabholkar was admitted to the surgical ward with complaints of recurrent epigastric pain for the past 6
months. The pain was intermittent, burning in nature, and aggravated by fasting, relieved by food intake. He also
reported associated symptoms of bloating and occasional nausea. There was no history of vomiting blood or black tarry
stools.

• Past Medical History:

The patient had a history of smoking (10 pack-years) and occasional alcohol consumption. No known history of chronic
illnesses or previous abdominal surgeries.

• Social History:

○ Occupation: Businessman
○ Diet: Regular, spicy food intake
○ Habits: Smoking (10 pack-years), occasional alcohol use
○ Family History: No significant history of gastrointestinal diseases
○ Physical Examination:

Vital Signs: Stable

Abdominal Examination: Mild epigastric tenderness on palpation; no rebound tenderness or guarding; no organomegaly
Other Systemic Examination: Unremarkable

• Negative History:
Gastrointestinal Symptoms:

Vomiting Blood or Coffee Grounds: The patient denies any episodes of vomiting blood or coffee ground-like material.
Black Tarry Stools (Melena): There is no history of passing black, tarry stools, suggesting an absence of upper
gastrointestinal bleeding.
Gastrointestinal Surgeries:

Previous Abdominal Surgeries: Mr. Ramesh Kumar has no history of previous abdominal surgeries, indicating that the
current symptoms are not related to any surgical procedures.
Chronic Illnesses:
 Chronic Medical Conditions: The patient has no known chronic medical conditions such as diabetes, hypertension, or
chronic kidney disease, which could contribute to gastrointestinal symptoms.
Medication History:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Mr. Kumar denies regular use of NSAIDs, which are known to be a
common cause of peptic ulcers.
Steroid Use: There is no history of chronic steroid use, which could increase the risk of peptic ulcer development.
Diet and Lifestyle:

Spicy Food Intake: While the patient reports a regular diet, including spicy foods, there is no history of excessive spicy
food intake exacerbating symptoms.
Smoking and Alcohol Consumption: Although the patient has a history of smoking and occasional alcohol use, there is no
indication that these habits directly contribute to the current presentation.
Family History:

Gastrointestinal Diseases in Family: There is no significant family history of gastrointestinal diseases, ruling out a familial
predisposition to peptic ulcer disease.
Psychosocial History:

Stressors or Psychiatric Illness: The patient denies any recent significant stressors or psychiatric illnesses that could
contribute to the exacerbation of gastrointestinal symptoms.
Allergic Reactions:

Allergies to Medications: The patient does not report any known allergies to medications, facilitating the choice of
appropriate treatment options.

• Differential Diagnosis:
Peptic Ulcer Disease (PUD):

Description: Peptic ulcers, including gastric and duodenal ulcers, are characterized by mucosal damage in the
gastrointestinal tract, often caused by Helicobacter pylori infection or nonsteroidal anti-inflammatory drug (NSAID) use.
Reasoning: The patient's symptoms, positive Helicobacter pylori serology, and endoscopic findings of a duodenal ulcer
point toward peptic ulcer disease as the primary diagnosis.
Gastritis:

Description: Inflammation of the gastric mucosa, which can be acute or chronic.

Reasoning: Gastritis can present with epigastric pain and may be associated with Helicobacter pylori infection or other
factors. Endoscopy is crucial for differentiation from peptic ulcers.
Gastroesophageal Reflux Disease (GERD):

Description: Chronic condition where stomach acid flows back into the esophagus, leading to symptoms like heartburn
and regurgitation.
Reasoning: GERD may present with epigastric discomfort, and it is essential to consider this diagnosis, especially if the
patient reports symptoms worsening when lying down.
Gastric Cancer:

Description: Malignant growth in the stomach, which can cause epigastric pain and other gastrointestinal symptoms.
Reasoning: Although less common, gastric cancer needs consideration, particularly in patients with risk factors such as
older age and persistent symptoms despite treatment.
Functional Dyspepsia:

Description: Chronic upper abdominal pain or discomfort without an evident organic cause.
Reasoning: If the patient's symptoms persist despite treatment and no structural abnormalities are found, functional
dyspepsia might be considered.
Pancreatitis:

Description: Inflammation of the pancreas, which can cause abdominal pain, nausea, and vomiting.
Reasoning: Although less likely, pancreatitis can present with epigastric pain. Serum amylase and lipase levels should be
considered for further evaluation.
Biliary Colic:

Description: Pain caused by gallstones obstructing the bile duct.

Reasoning: Symptoms may mimic those of peptic ulcer disease, and imaging studies such as ultrasound can help rule out
gallstone-related issues.
Inflammatory Bowel Disease (IBD):

Description: Chronic inflammation of the gastrointestinal tract, including conditions like Crohn's disease and ulcerative
colitis.
Reasoning: While less likely, IBD can sometimes present with upper gastrointestinal symptoms, and a thorough history
and imaging studies can help exclude this possibility.
Cardiac Causes:

Description: Cardiac issues, such as angina or myocardial infarction, can sometimes present with upper abdominal
discomfort.
Reasoning: Considering the age and risk factors, cardiac causes should be ruled out, especially if there are atypical
features or if the patient has a history of cardiovascular disease.
Psychosocial Factors:

Description: Stress and psychological factors can contribute to gastrointestinal symptoms.

Reasoning: Psychosocial factors should be considered, and the patient's stress levels and mental health should be
explored during the evaluation.

Extra details

Note : management and treatment not mentioned

As it contains aspects of general medicine and pharmacology.

Source : https://u.osu.edu/pepticulcercasestudy/

Created by ; Atharva Sawant