Case presentation on Duodenal ulcer

DEFINITION:
A crater(ulcer) in the lining of the beginning of the small intestine (duodenum).
CAUSES OF DUODENAL ULCER
Infection with helicobacter pylori
Anti-inflammatory medicines
Other factors such as smoking, stress and drinking

1. CASE PRESENTATION ON DUODENAL ULCER PRESENTED BY: MAKBUL HUSSAIN CHOWDHURY 15Z11T0006 Pharm.D 5th YEAR

2. DEFINITION: A crater(ulcer) in the lining of the beginning of the small intestine (duodenum). CAUSES OF DUODENAL ULCER Infection with helicobacter pylori Anti-inflammatory medicines Other factors such as smoking , stress and drinking

3. SYMPTOMS OF DUODENAL ULCER Pain in the upper tummy(abdomen) just below the breastbone (sternum) Bloating Retching Feeling sick

4. DIAGNOSIS Testing for blood, stool or a sample of tissue from digestive tract(biopsy) that can be tested for H.pylori Endoscopy(upper small intestine to check for an ulcer)

5. COMPLICATIONS OF DUODENAL ULCER Perforation is a much less frequent complication than bleeding Use more non-steroidal anti-inflammatory drugs(NSAIDS),the incidence of perforation is increasing

6. SUBJECTIVE DATA PATIENT NAME : Xxx AGE: 34yrs GENDER :Female DEPARTMENT : General medicine DOA : 23/11/19 CHIEF COMPLAINTS 3 episodes of hemetemesis since yesterday 1 episodes of black stools since 2 days

7. PAST HISTORY Nil SURGICAL HISTORY Nil

8. PERSONAL HISTORY Diet: Mixed(spicy food in take) Sleep: Normal Bowel and Bladder : Regular Appetite: Normal

9. OBJECTIVE DATA Temperature : Afebrile Pulse rate : 70bpm Blood pressure : 110/70mm Hg Respiratory rate : 20/min CVS: S 1 S 2  PA: Soft, non-tender.

10. S.NO LAB TESTS NORMAL VALUE LAB VALUE 1. Haemoglobin 13.5-17.5gm% 9.6gm% ↓ 2 WBC count 4,000-11,000cells/ Mm 3 9,900cells/ Mm 3 3 Neutrophils 40-80% 66% 4 Lymphocytes 20-40% 24% 5 Eosinophils 01-06% 6% 6 Monocytes 02-10% 4% 7 MCHC 32-36% 41.3% ↑ 8 BUN 15-40mg/dl 41mg/dl ↑ 9 Sr. Creat 0.5-1.5mg/dl 1.6mg/dl ↑ 10 Sodium 135-155mmol/L 132mmol/L ↓

11. SI NO LAB TESTS NORMAL VALUE LAB VALUE 11 PCV 33-47% 22.3% ↓ 12 potassium 3.5-5.5mmol/lit 4.1mmol/lit

12. ASSESMENT DUODENAL ULCER

13. THERAPEUTIC GOALS To reduce the disease condition To prevent further progression the disease. To stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies .

14. TREATMENT CHART SI.NO BRAND NAME GENERIC NAME INDICATION DOSE ROA FREQUENCY 1. T.PAN Pantoprazole Acidity 40mg PO BD 2 T.AUTRIN Ferrous fumarate+Folic acid+Vit-B12 Vitamin deficiency 325mg PO OD 3 INJ. LASIX Furosemide Given before blood transfusion 1amp IV 4 T.CIPORIC ciprofloxacin Antibacterial agent 250mg Po OD 5 T.ONDEO-R Ondansetron Antiemetic 4mg PO BD

15. PROGRESS DAY 1 Patient conscious & coherent TEMP : A febrile PR:72bpm BP:120/80mm Hg Blood vomitings and blood stools MEDICATION : Blood transfusion is done in the morning INJ. PAN,T.AUTRIN,INJ. LASIX(given before blood transfusion)

16. DAY 2 Patient conscious&coherent Temp : A febrile PR:72bpm Bp:110/70mmHg No Fresh complaints MEDICATIONS : CST DAY 3 NO FRESH COMPLAINTS BP:110/70mm Hg PR:88bpm MEDICATIONS: CST

17. DISCHARGE MEDICATION T.PAN 40MG (BD) T.AUTRIN(OD) T.ONDANSETRON(BD) AMOXICILLIN(BD)

18. PHARMACIST INTERVENTION ciprofloxacin and ondansetron interaction is abnormal heart rhythm. Suggestion: removing the ciprofloxacin and adding the amoxicillin(125mg)

19. PATIENT COUNSELLING REGARDING DRUGS TAB. AUTRIN: Should be taken on an empty stomach.Do not stop the drug untill doctor says to do so TAB.PAN: One dose should be taken with empty stomach in the morning and other dose taken at night after meal Do not crush or chew the tablets

20. LIFE STYLE MODIFICATIONS Take high fibre rich food i.e vegetables such as bottle gaurd,snake guard, peas etc Donot eat spicy or acidic foods such as oranges,pickles etc To eat regular meals in a relaxed setting and to avoid over eating NSAIDS are not taken untill doctor prescribed If any further complications occur consult doctor immediately

21. Thank you