I.

Introduction

Peptic Ulcer Disease involves a break in continuity of the esophageal, gastric, or

duodenal mucosa. An ulcer may occur in any part of the GI tract that comes into contact with
gastric juices (hydrochloric acid and pepsin). The ulcer may be found in the esophagus, stomach,
duodenum, or the jejunum after gastroenterostomy. It is usually as a result of inflammation
caused by the bacteria H. pylori, as well as from erosion from stomach acids.

Duodenal ulcers have a higher incidence than gastric ulcers. These ulcers usually occur
within 1.5 cm (0.6 inch) of the pylorus and are usually characterized by high gastric acid
secretion. Some are associated with normal gastric secretion that is associated with rapid
emptying of the stomach. Stimuli for acid secretion include protein-rich meals, alcohol
consumption, calcium, and vagal stimulation. Duodenal ulcer pain often awakens the patient at
night due to pain. It is characterized by a gnawing or burning sensation that occurs 2-3 hours
after meals.

Gastric ulcers tend to heal within a few weeks. The reflux of bile acids through an
incompetent pylorus into the stomach may break the mucosal barrier. Decreased blood flow to
the gastric mucosa may make the duodenum more susceptible to gastric acid and pepsin trauma.
It is characterized by a gnawing or burning sensation and occurs after meals.

In Peptic Ulcer Disease, the most common symptom is a burning sensation or pain in the
middle of your abdomen between your chest and belly button. Typically, the pain will be more
intense when your stomach is empty, and it can last for a few minutes to several hours.

Other common signs and symptoms of ulcers include:

 dull pain in the stomach

 weight loss

 loss of appetite

 nausea or vomiting

 bloating

 feeling easily full

 burping or acid reflux

 heartburn (burning sensation in the chest)

 pain that may improve when you eat, drink, or take antacids

 anemia (symptoms can include tiredness, shortness of breath, or pallor)

 dark, tarry stools

 vomit that’s bloody or looks like coffee grounds

Mrs. C.A., 76 yrs old, was admitted at The Doctors’ Hospital Inc. (TDHI) last January 7,
2017. She was initially diagnosed with Moderate Anemia secondary to Upper Gastrointestinal
Bleeding secondary to Bleeding Peptic Ulcer disease and was finally diagnosed with Upper
Gastrointestinal Bleeding secondary to Bleeding Peptic Ulcer Disease.

According to the client, Last December 31, 2016, she prepared a Media Noche in
celebration for the coming year 2017. She was not able to eat the meal she has prepared due to an
upset stomach. She defecated and according to Mrs. C.A, she described the color and texture of
her stool as “Chocolate Cake”. On January 3, 2017 (Tuesday), she decided to have a laboratory
test. The result shows that her hemoglobin is 75x10^12/L. January 5-6, 2017, Mrs. C.A.
manifested signs and symptoms of anemia and BPUD such as: abdominal pain, lightheadedness,
difficulty of breathing, dizziness, body malaise and vertigo before they decided to admit at TDHI
the next day.

We chose Mrs. C.A’s case because the group found the Bleeding Peptic Ulcer Disease as
a topic that challenged us intellectually. Her case was something new to us and because of this;
we wanted to expand our knowledge and understanding on the cause of her condition. Mrs. C.A
is a bubbly, energetic and a very caring grandmother to us. At first, she denied to be interviewed
because she was tired, restless and was stressing on a lot of things. However, during our second
day of duty, she was feeling much better than before.

To enjoy good life, to bring true happiness to one’s family, one must learn to take care
one’s health in all aspect. He/she must first discipline and control one’s own mind because a
calm mind brings inner strength and self-confidence that a healthy body needs. In conclusion, the
group wants to emphasize that being healthy outside starts from the inside.