Case Study on Peptic Ulcer

Disease

General Information
Name: Patient Y
Age: 67 years old
Gender: Male
Birth Date:
Rank in the Family:

5th among the nine

siblings

Civil Status: Divorce

Nationality: Filipino

Height: 56 ft
Weight: 45.4 kg
Date and Time of
Admission: February
22, 2010

Means of Admission: Experiencing abdominal

pain, feeling of weakness, tarry stool and
vomiting that hindered him from doing his daily
activities.

The patients

activities focus on
farming only.
patient also
mentioned that in
year 2000 he
acquired PTB and
underwent
treatment for six
months and was
cured without
being
hospitalized.

meals 8am-12nn7pm. He takes

his multivitamins
and ferrous
sulfate daily.
Patient now eats
anything he
wants. His
appetite
improved since
he left the
hospital. This
indicates that his
recovery is doing
well. He is drinks

Chief Complaint and Medical

Diagnosis
For the past year, the patient had

been experiencing abdominal pain,

feeling of weakness, tarry stool and
vomiting that hindered him from
doing his daily activities. Because
pain was becoming more intense,
patient decided to seek medical
advice at EVRMC.
PUD

Incidence
The incidence rate of peptic ulcer bleeding

did not change between 19851986 and

20072008, but decreased in the age group
75 years and increased in the age group
>75 years. The use of low-dose aspirin and
NSAIDs increased substantially over time,
and H. pyloriinfection was still present in
51% of these patients in 20072008.

Pathophysiology
Peptic ulcers result from an

imbalance between factors that

can damage the gastro duodenal
mucosal lining and defense
mechanisms that normally limit the
injury. Aggressive factors include
gastric juice (including hydrochloric
acid, pepsin, and bile salts refluxed
from the duodenum),H pylori, and
NSAIDs.

Prognosis
Outcome for this PUD case is excellent. No

complications were reported, patient is

expected to recover as expected, and will
build immunity to the disease.

Assessment of Nutritional
Status

Anthropometric assessment
Age: 67 years old
Height: 56 ft. or 167.74cm
Weight: 100 lbs.

Result

Desirable
BodyWeight

61

BodyMass
Index(BMI)

16.2

Remark

Severely
Underweight

DATE

TEST

RESULT

RANGES/
NORNAMAL
VALUE

INTERPRETATIO
N

02-2310

Fecalysis

Black/Watery
Hookworm:
Ova+

Brown

Tarry stool
(Melena) due to
bleeding

Yellow
Clear
6.5
1.015
Negative

Yellow-straw
Clear
5.0-8.0
1.005-1.030

Normal
Normal
Normal
Normal

6.4

5-10.0 X10.9/L

11.2
0.12

14-18gm%
40-50%

High bacterial
infection
low GI bleeding
Low blood loss

02-23- Urinalysis:
10

Color:

Transparency

Reaction

Sp. Gravity

Albumin
02-25- Hematology
10

RBC

WBC

HGB
HCT
Differential Count:
Neutrophils
Lymphocytes

75%
25%

40-60%/L
20-40%/L

High bacterial
infection
bacterial infection

Clinical
Hair was all grey, equally distributed

and with fine texture.

Skin was pale, dry, wrinkled, cool to
touch and rough due to aging. No signs
of edema, lesions or dehydration noted.
Vital Sign
Temperature

36.4C axillary

Heart Rate

63 bpm

Respiratory Rate

16 cpm

Blood Pressure -

130/70 mmHg taken at R arm

Dietary
Encourage patient to eat and informed him

that nutrition is very important at any

medication.
Stress to patient the importance of
adequate intake of caloric and nutrient food
rich in calcium and vitamin D to increase
bone density.
Advise patient to exclude alcohol,
carbonated beverages, coffee, spicy foods
and meat extracts from his diet.
Encourage patient to eat three regular
meals per day and in a relaxed setting and
to avoid overeating.

Drugs Interaction
Metronidazole-unpleasant metallic taste,

anorexia, nausea, vomiting, diarrhea, GI

upset and cramps.
Paracetamol- In rare cases hypersensitivity
reactions, predominantly skin allergy
(itching & rash) may appear, long term
treatment with high doses may cause a
toxic hepatitis with following initial
symptoms; nausea, vomiting, sweating and
discomfort.
Chlorheniramine maleate- Epigastric
distress, anorexia, increase appetite &
weight gain, nausea, vomiting,

Ciprofloxacin- pseudomembranous colitis,

diarrhea, nausea, abdominal pain or

discomforts, constipation, dyspepsia,
flatulence, oral candidiasis, vomiting.

NPC
Assessment
67 years old male with Peptic Ulcer
Ht:56 ,Wt: 45.4kg, BMI: 16.2
Medication: Metronidazole, Paracetamol,

Chlorheniramine maleate, Ciprofloxacin,

lansoprazole.
Vitamin Supplement: multivitamins and
ferrous sulfate
Diagnosis
Weight loss related to Peptic Ulcer Disease
as evidenced by abdominal pain.

Intervention
Weight loss: The patient will maintain his

energy intake of 1830 kcal per day by

eating 3 meals a day by following the free
meal plan obtain from the hospital dietitian.
Monitoring and Evaluation
The Patient or other family members will
keep log of his food intake, if he complete
the 3 meals and checking the intake of
fruits.

Meal Time

Menu

Ingredients

Breakfast

Cereal
Milo
Honey
Apple
Pandesal w/ egg

AM Snack

Guava

Rice
Chopsuey w/
chicken

Banana

Rice
Sauted string
beans w/ fish

Rice cereal
milo
honey fresh
Apple Red
Pandesal
Matonnaise
Sunny side up
egg
Ketchup

Lunch

PM Snack
Dinner

HH
Measurements
1 cup
3 Tbs
2 tsp
4 pc
1 tsp
1 pc
1 Tbs
2 pc

Boiled Rice
Cabbage
Bell pepper
Cauliflower
Carrots
Banana fruit

2 cups
cup
cup
cup
cup
1 pc

Boiled rice
String beans

2 cups
1 cup

Goals of Medical Nutrition

Therapy
A diet for PUD is an eating plan

that limits or does not include

foods that irritate your stomach.
Your stomach can be irritated by
foods that increase stomach acid.
The need to limit or avoid drinks
and foods that cause your
symptoms, such as stomach pain,
heartburn, or indigestion.

The patient is already around his

70s, so his physical activity is

mostly sitting down and few walk
around his house. He can no longer
prepare food for himself that is why
he needs assistance from his family
and others.
Encourage patient to eat and
informed him that nutrition is very
important at any medication.
Stress to patient the importance of

Advise patient to exclude alcohol,

carbonated beverages, coffee, spicy

foods and meat extracts from his diet.
Encourage patient to eat three regular
meals per day and in a relaxed setting
and to avoid overeating. Advise his
family to provide attractive meals and
an aesthetically pleasing setting at
meal time.