Assessment Practice
Clinical Case Studies
Duodenal ulcer-a case of GI bleed
Look at this clinical case study and answer the questions
Case Study 3. Tom
Diagnosis
- Tom had felt weak and under the weather for some days, and had started passing foul smelling, pitch black stools one Sunday. Frightened he visited casualty late at night in considerable discomfort.
- The hospital doctor suspected a GI(gastro-intestinal) bleed, carried out an examination and admitted him for tests.
- Apart from the usual blood tests, Tom also underwent endoscopy.
- The tests confirmed that Tom had an ulcer in his duodenum
- The doctor explained that this was often linked to infection by Helicobacter pylori(H.pylori), a bacterium that can thrive in the conditions found in the stomach. This was also the culprit in Tom's case
Treatment
- The hospital doctor put Tom on a combination of drugs.
- He explained to Tom what each was for. The drugs included the following:
- an antacid,
- cimetidine to reduce acid secretion,
- a drug called omeprazole to also suppress acid production and another drug to aid healing,
- an antibiotic
Tom made a good recovery, but was advised to stop smoking, and to avoid taking aspirin in the future.
Clinical questions
- Why had Tom felt weak and under the weather?
- Why had his GI bleed resulted in stools of the type mentioned rather than bright red ones?
- What was the purpose of the endoscopy?
- Where is the duodenum located?
- What are the 'conditions in the stomach' ?
- Acid is not freely produced in the duodenum. Why then was Tom taking antacids and acid suppressants?
- Give two reasons for the antibiotic treatment
- Tom was at first reluctant to take antibiotics because he had read they could lead to vitamin deficiency. How could this occur?
- Why the advice to avoid aspirin?