CARDIOVASCULAR SYSTEM SGD CASE ii.

Duodenum –
iii. Jejunum –
A 61-year-old American woman was referred to
iv. Lower esophagus –
a Gastroenterology Clinic from primary care
v. Muscularis propria layer –
provider due to consistent discomfort and
4. What are the risk factors / causes of the
significant weight loss. She looked for a PCP’s
medical condition?
advice as she had a tarry stool in the early
Risk factors that make ulcers more likely
morning which she had never experienced
include:
before. She presented with a 2-month history of
• Frequent use of nonsteroidal anti-
burning pain in the epigastric abdomen and
inflammatory drugs (NSAIDs), a group
chest which radiated toward her back. Her pain
of common pain relievers that includes
worsened after taking aspirin and drinking coffee
ibuprofen (Advil® or Motrin®).
and was relieved after taking antacids. She had
• Helicobacter pylori (H. pylori) bacteria.
previously lost 10 pounds in 2 months due to
decreased intake caused by the feeling of People who have H. pylori and who
bloating, early fullness, and stomachaches frequently use NSAIDs are more likely
between meals. She also reported nausea and to have damage to the mucus layer,
vomiting. She expressed concern especially and their damage can be more
because the food appeared undigested when severe.
she vomited. She also reported doubling her • A family history of ulcers.
NSAID intake due to increased knee pain. She • Illness such as liver, kidney or lung
looked pale and exhausted when she entered disease.
the clinic. Past medical history shows Gastritis • Regularly drinking alcohol.
with Helicobacter pylori (H. pylori) infection, • Smoking.
diagnosed 5 years ago. Resolved with 5. What are the ways to prevent these risk
pharmacotherapy, frequent recurrence. factors/ causes?
Certain lifestyle choices and habits can
Diagnosis: Peptic Ulcer Disease
reduce your risk of developing peptic ulcers:
SAMPLE GUIDE QUESTIONS • not drinking more than two alcoholic
1. What specific parts of the digestive beverages a day
system is affected in this case? • not mixing alcohol with medication
• the inner lining of the gastrointestinal • washing your hands frequently to avoid
(GI) tract – muscularis propria layer of infections
the gastric epithelium (because of • limiting your use of ibuprofen, aspirin,
gastric acid secretion or pepsin) and naproxen (Aleve)
• stomach • Maintaining a healthy lifestyle by quitting
• duodenum smoking cigarettes and other tobacco
• jejunum use and eating a balanced diet rich in
fruits, vegetables, and whole grains will
• lower esophagus
help you prevent developing a peptic
2. What are the normal functions of the body
ulcer.
system involved in this case?
Digestion of food Doctors treat ulcers with medications,
3. Discuss the specific structure involved as including:
to:
• Proton pump inhibitors (PPI): These
a. The structure / anatomy
drugs reduce acid, which allows the
i. Stomach –
ulcer to heal. PPIs include Prilosec®,
ii. Duodenum –
Prevacid®, Aciphex®, Protonix® and
iii. Jejunum –
Nexium®.
iv. Lower esophagus –
• Histamine receptor blockers (H2
v. Muscularis propria layer –
blockers): These drugs also reduce
b. The function / physiology
acid production and include
i. Stomach –
 Tagamet®, Pepcid®, Zantac® and o throat soreness or hoarseness
Axid®. o feeling a lump in your throat
• Antibiotics: These medications kill o ongoing cough
bacteria. Doctors use them to treat H. • Gastroesophageal reflux disease (GERD)
pylori. can cause epigastric pain as well as burning
• Protective medications: Like a liquid pain in the chest, a feeling of liquid coming
bandage, these medications cover the up into the back of the throat and a persistent
ulcer in a protective layer to prevent irritating cough.
further damage from digestive acids • Gastritis – is when your stomach lining gets
and enzymes. Doctors commonly red and swollen (inflamed). Things that can
recommend Carafate® or Pepto- irritate your stomach lining includes alcohol,
Bismol®. caffeine, and spicy foods.
6. What is the effect of aging in the body Coffee contains many acids, such as
system involved? chlorogenic acid and N-alkanoyl-5-
The prevalence of Helicobacter pylori hydroxytryptamide, which have been
increases with age and can have an shown to increase stomach acid
important role in the development of ulcers. production.
Nonsteroidal anti-inflammatory drugs also
contribute to the increased incidence of Symptoms and causes of gastritis na
ulcers and the development of complications connected sa case:
in the elderly. Although management of ulcer o Nausea and vomiting
disease in the elderly is similar to that in the o Feeling of fullness or burning in your
younger population, consideration must be stomach
given to the potential for increased incidence o Loss of appetite
of side effects and medication interactions. o Blood in your vomit or stool (a sign that
7. What are the approaches done by a your stomach lining may be bleeding)
professional Medical Laboratory Scientist o Long-term use of aspirin and over-the-
in this case? counter pain and fever medicines
8. As a future MLS, what advise/s will you (nonsteroidal anti-inflammatory drugs or
give to enhance and maintain the health NSAIDs)
of the body system involved in the case? 2. Helicobacter pylori (H. pylori) infection –
ADDITIONAL INFORMATION infection occurs when H. pylori bacteria
infect your stomach. It can damage the tissue
1. burning pain in the epigastric abdomen and in your stomach and the first part of your
chest explanation small intestine (the duodenum). The H. pylori
Epigastric pain – pain or discomfort right below bacteria stick to the layer of mucus in the
the ribs in the area of your upper abdomen. digestive tract and cause inflammation
(irritation), which can cause this protective
Possible causes: lining to break down. It can cause open sores
• Acid reflux – when some of your stomach called peptic ulcers in your upper digestive
acid or the food in your stomach washes tract.
back up into your esophagus. When this 3. Tarry stool – a sign of a problem in the
happens, it can cause pain in your chest and upper digestive tract. It most often indicates
throat. Common symptoms of acid reflux that there is bleeding in the stomach, small
include: intestine, or right side of the colon. The term
o Heartburn is a result of acid reflux. This melena is used to describe this finding.
can cause burning chest pain. 4. Food appeared undigested when vomited –
Indigestion (dyspepsia) is a name for Regurgitation is when food, liquid, or
digestive symptoms that happen when stomach acid comes up from the stomach
you eat types of foods that don’t seem to into your mouth. It occurs in 80% of people
agree with you. with GERD. Other causes include stomach
o abnormal acidic taste in your mouth
 ulcers, gastritis, and being pregnant or
overweight.
5. Pharmacotherapy – the treatment of a
disorder or disease with medication
6. Peptic Ulcer Disease – occurs when open
sores, or ulcers, form in the stomach or first
part of the small intestine. Many cases of
peptic ulcer disease develop because a
bacterial infection eats away the protective
lining of the digestive system.
There are three types of peptic ulcers:
• gastric ulcers: ulcers that develop
inside the stomach
• esophageal ulcers: ulcers that develop
inside the esophagus
• duodenal ulcers: ulcers that develop in
the upper section of the small intestines,
called the duodenum