GI/ Peptic ulcer/ Pancreatitis

Case Study 2a Peptic Ulcer

Roger, a sixty-four year old retail store manager, had recently been waking up in the middle of the night and experiencing during the middle of the day abdominal pain. This was happening on a regular basis. He decided to consult a physician.

The doctor noted that Roger seemed fine other than his stomach discomfort.

Roger was referred to a specialist in internal medicine and had a procedure called an endoscopy. The endoscopy was performed at a hospital. During the procedure, a long, thin tube was inserted into Rogers\’s mouth and directed into his digestive tract. The end of the tube was equipped with a light source and a small camera which allowed the doctor to observe the interior of Roger\’s stomach. The endoscope was also equipped with a small claw-like structure that the doctor could use in order to obtain a small tissue sample from the lining of Roger\’s stomach, if needed.

The endoscopy revealed that Roger had a peptic ulcer. Analysis of a tissue sample taken from the site showed that Roger had an infection that was caused by Helicobacter pylori bacteria. Roger was given prescriptions for two different antibiotics and a medication that would decrease the secretion of stomach acid. Roger scheduled a return appointment for another endoscopy procedure in 6 months.

Case Background

A peptic ulcer is a sore that occurs in the lining of a part of the gastrointestinal tract that is exposed to pepsin and acid secretions. Most peptic ulcers occur in the lining of the stomach or duodenum. 90% of all duodenal ulcers and 80% of all gastric ulcers are caused by H. pylori infection. Most of the remaining peptic ulcers are caused by long-term usage of certain anti-inflammatory medications like aspirin.

There is still some question as to how H. pylori is spread. However, H. pylori has been identified in the saliva of infected individuals and may be spread via this fluid. H. pylori bacteria have the ability to survive the acid environment in the stomach because they produce enzymes that neutralize stomach acids. They also have the ability to move through the mucous membrane lining the stomach or duodenum and take up residence in the underlying connective tissue. The damage to the mucous membrane that results from a H. pylori infection allows pepsin and hydrochloric acid to further damage the wall of the stomach or duodenum. The sore that results is the peptic ulcer.
DISCUSSION QUESTIONS Case Study 2a:

1.Describe the functions of the following components of gastric juice: Hydrochloric acid, Pepsinogen, Pepsin, Intrinsic factor.

2.Why dont the components of gastric juice damage the wall of the stomach in the absence of a H. pylori infection?

3.Why dont most other types of bacteria produce ulcers?

Case Study 2b Pancreatitis

At age 52, Arnold entered the hospital with complaints of a high fever, nausea, loss of appetite, and a dull, continual pain in the left side of the back. In addition, he had diarrhea of a particularly foul odor and yellow color. . He had also lost 18 pounds over the last month and a half. Please study the probing questions and the answers to this Pancreatitis Case Study thoroughly before answering our Discussion questions.

Questions: Excessive exposure to alcohol can cause inflammation of certain digestive organs, such as the stomach. Inflammation of which organ(s) might be causing Arnold\’s back pain? Based upon the location of this pain, would you guess that the organ in question is a retroperitoneal organ or an organ attached to the abdominal wall by a broad sheet of mesentery? Explain your answer.

Answers: Chronic exposure to alcohol can cause pancreatitis – – i.e. inflammation of the pancreas. Since the pancreas is a retroperitoneal organ, the dull, throbbing pain associated with pancreatitis is often felt in the back. It is therefore likely that Arnold is suffering from alcohol-induced pancreatitis. The destruction of exocrine cells in the pancreas reduces this organ\’s ability to secrete digestive enzymes and HCO3- ions into the duodenum during meals. Consequently, many of the nutrients in Arnold\’s meals will never be completely digested, and therefore never absorbed into the bloodstream. Arnold will slowly lose weight due to this malabsorption syndrome.

Based upon the function of the organ in question, what is causing the \”steatorrhea\” and weight loss?

Answers: Since many of the nutrients Arnold ingests during a meal pass through the intestines unabsorbed, they osmotically draw water from the bloodstream into the intestinal lumen, causing an \”osmotic diarrhea.\” The high fat content of the stool gives it a foul odor and yellowish color – – a condition called steatorrhea. The inability of Arnold to absorb the nutrients of his meal will cause him to slowly lose weight. This malabsorption syndrome can now be treated with the ingestion of pancreatic enzymes with each meal.

Discussion Questions Case Study 2b:

1.What is Pancreatitis?

2.What is Steatorrhea?

3.What are some of the pancreatic enzymes that could be used to treat Arnold?

4.What did you learn from this case study on how to approach a gastrointestinal complaints by a patient?

5.What did you learn that was new?
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