site- ant,post(specific)

exacerbating factor - after, before meals

characteristic pain - cramping , burning, sharp pain

radiation- ?(to the rt hypochondriac)(back, shoulder and chest)

As, symptoms- vomiting , nausea, diarrhea, bloating, weigh loss

severity- rate

medical history -

• NSAIDS drugs effect on stomach

• previous surgery

• pre-existing med condition

family history

• autoimmune

• lactose intolerance, Hypertension , diabetes

• family members

social huistory

• alcohol

• smoker

• diet(spicy food,fatty, meal time)

• occupation

• any trauma on the site

travel histroy

• previous travel

• 
  

-initial pain somewhere else

band like fasion, - pain back of the body resembles band

haematochezia - blood come out from anus

• originates from lower part of git

over-the-counter analgesics - non prescription medicines used for moderate inflammation , fever & pain

haematemesis - vomiting blood

no changes in bowel habits - x constipate & diarrhea

radiated to the back in a band-like fashion - like ulcer, disturb git nerve, radiated to back

hunger and consuming spicy food - stomach acid still produce, but no digestion & spicy enhance acidity & increases the pain

what food that relates to pain in abdominal region?? - food can fx as buffer, releaves the acid

dua jenis peptic ulcer - duodenal ulcer punya case if intake of food closure of pyloric sphinter - ulcerated part of duodenum have no contact with acid due to closure

mech. of acid gastric secretion regulation - H+/K+ proton pump

fx yg pengaruh secretion - binding of histamine, ACh & gastrin can enhance HCl secretion - positive feedback

when pH too low, stomach secretes somatostatin, secretin & GIP & CCK - inhibitor & negative feedback for HCl secretion

temporarily relieved by taking food or drinking milk - food neutralize acid & milk is natural antacid - neutralize the acid - rule out lactose intolerance, certain cases of gerd

woke at night because of the pain - lie down , concetrated at ulcer part, night - git active, acid can still be produced

nausea and vomited once, - occur cuz stomach try to expel the gastric content due to pain reflux

no signs and symptoms of diarrhoea, constipation, melaena, haematemesis, haematochezia, loss of weight or loss of appetite.

The stool was normal in colour and consistency - no bleeding, no rupture& food poisoning , rulee out cond. causesw git bleeding

He did not notice any changes in bowel habits - intestine region normal, only upper of git region got problem

over-the-counter analgesics consisting of acetaminophen, aspirin, and caffeine - can cause peptic ulcer

aspirin - irritates & decreases mucus in stomach lining

financial manager under severe pressure - sit longer period, skip meals due to under pressure

smoking habit - tobacco enhance acid production & decrase bicarbonate

nicotine - stimulates acid production

reduce mucus production, vasoconstriction, decrease the cell ability to produce mucus

social drinker - occasionally consume alcohol, after party worsen condition

• temp

• Heart rate

• resp rate

• O2 lvls

• blood pressure

Physical examination

• jaundice

• palpate - hepatomegaly, feel at organ position, check ternderness, any pain occur

• bowel sound

Full Blood count - for infection

• AMYLASE & LIPASE SERUM - if elevated, got abnormalities

endoscopy aka egd - check ada ulcer or not

ultrasound - find gallstones

urease test - detect helicobacter pylori

palpable masses - palpate for abnormal lump

Bowel sounds - sound made by the movement of intestine as they push food through

• BP - normal, no bleeding at abdomen

• No pallor - no anemia, oxygen respiration normal

• no jaundice - no problem with liver , no hyperbilirubinemia

• abdomen soft but tender epigastric due to inflammation

• no rebound tenderness elicited or palpable masses were found - no cyst occur at the organ, no enlargement of organ, rule out cancer, rule out peritonitis

• Bowel sounds were normal - no problem at the digestion system

Full Blood count - focus on WBC

• AMYLASE & LIPASE SERUM - if elevated, got abnormalities

urease test - detect helicobacter pylori

endoscopy aka egd - check ada ulcer or not

• should be high but patient take NSAID

showed clean-based ulcer at the posterior wall of the first

part of the duodenum

• no bleeding

Urease test for Helicobacter pylori performed during

the OGD was positive

• H. pylori not invade blood

• infected from environment

omeprazole for four weeks,

• proton pump inhibitors- inhibit parietal cell secrete gastric acid

metronidazole and clarithromycin for two

weeks and was discharged in stable condition

• protein synthesis inhibitor for bacteria

instructed to avoid nonsteroidal anti-inflammatory drugs

(NSAIDs). He was also recommended to quit smoking, stop alcohol

drinking

• increase secretion of gastric acid

change type of meal and frequency of meal intake

• reduce spicy food

• drink milk