RESPONCES WEEK 5 ADVANCDED HEALTH

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Nov 24, 2024

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Response 1 When assessing a patient with peptic ulcers, it is important to consider various signs and symptoms that may indicate the presence of peptic ulcers. The hallmark of peptic ulcers is abdominal pain characterized by burning or gnawing pain in the upper abdomen (Abbasi- Kangevari et al., 2022). This pain is typically located between the breastbone and the belly button and may come and go. It can be worse on an empty stomach or at night. Patients with peptic ulcers may experience indigestion, bloating, and a feeling of fullness after meals. They may also have recurrent heartburn, a burning sensation in the chest. Some individuals with peptic ulcers may experience nausea and vomiting, especially if the ulcer is located in the stomach. Reference Abbasi-Kangevari, M., Ahmadi, N., Fattahi, N., Rezaei, N., Malekpour, M.-R., Ghamari, S.-H., Moghaddam, S. S., Azadnajafabad, S., Esfahani, Z., Kolahi, A.-A., Roshani, S., Rezazadeh-Khadem, S., Gorgani, F., Naleini, S. N., Naderimagham, S., Larijani, B., & Farzadfar, F. (2022). Quality of care of peptic ulcer disease worldwide: A systematic analysis for the global burden of disease study 1990–2019. PLOS ONE, 17 (8). https://doi.org/10.1371/journal.pone.0271284 . Response 2 Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain. Peptic ulcers include gastric ulcers that occur on the inside of the stomach. Some signs to look for when assessing a patient with peptic ulcers include loss of appetite and weight loss (Sverdén et al., 2019). This is because chronic peptic ulcers can lead to a decrease in appetite and
unintended weight loss. In addition, dark or black stools also manifest peptic ulcers. Peptic ulcers can cause bleeding, which can result in the passage of dark, tarry stools due to the presence of digested blood. Reference Sverdén, E., Agréus, L., Dunn, J. M., & Lagergren, J. (2019). Peptic ulcer disease. BMJ, l5495. https://doi.org/10.1136/bmj.l5495 . Response 3 Peptic ulcers are open sores that develop on the lining of the stomach, small intestine, or esophagus. They can be caused by a bacterial infection (Helicobacter pylori) or long-term nonsteroidal anti-inflammatory drugs (NSAIDs) use (Kuna et al., 2019). Common symptoms include abdominal pain, bloating, indigestion, heartburn, and nausea. Diagnosing peptic ulcers involves obtaining the patient's medical history and conducting a physical examination. For instance, the provider asks the patient about their symptoms, duration, and any risk factors such as alcohol consumption, smoking, or medication use. In addition, the physical exam may include checking for signs of an ulcer, such as tenderness in the abdomen. Reference Kuna, L., Jakab, J., Smolic, R., Raguz-Lucic, N., Vcev, A., & Smolic, M. (2019). Peptic Ulcer Disease: A Brief Review of Conventional Therapy and Herbal Treatment Options. Journal of clinical medicine, 8 (2), 179. https://doi.org/10.3390/jcm8020179 . Response 4
Abdominal pain is the most common symptom of a peptic ulcer. The pain may be dull or burning and come and go over time. For some people, the pain may occur when the stomach is empty or at night, and it may go away for a short time after they eat. For other people, eating may make the pain worse. Various tests can be carried out. For instance, H. pylori Testing is important in this case, a breath, blood, or stool test to check for the presence of H. pylori bacteria (Di Saverio et al., 2014). Another test is endoscopy. This includes a thin, flexible tube with a camera inserted through the mouth to examine the upper digestive tract and take a tissue sample for biopsy. Lastly, Upper GI Series such as X-rays are taken after drinking a contrast solution to visualize the digestive tract. Blood Tests help identify anemia or assess liver and kidney function. Reference Di Saverio, S., Bassi, M., Smerieri, N. et al. (2014). Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper. World J Emerg Surg 9 , 45. https://doi.org/10.1186/1749-7922-9-45 . Response 5 In the case of peptic ulcers, it is essential to follow the prescribed treatment plan and attend regular follow-up appointments to monitor the healing process and manage any complications. Untreated or poorly managed peptic ulcers can lead to serious complications like bleeding, perforation, or obstruction. Surgical intervention may be necessary if medications and lifestyle changes do not effectively manage the ulcer. Surgical options, in this case, include ulcer excision, where the surgeon removes the ulcer and repairs the affected area; vagotomy, a procedure involving the cutting or removing the vagus nerve to decrease stomach acid
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production; and antrectomy, where the lower part of the stomach, antrum, is surgically removed to reduce acid production (Kavitt et al., 2019). Reference Kavitt, R. T., Lipowska, A. M., Anyane-Yeboa, A., & Gralnek, I. M. (2019). Diagnosis and treatment of peptic ulcer disease. The American Journal of Medicine, 132 (4), 447–456. https://doi.org/10.1016/j.amjmed.2018.12.009 . Response 6 I agree that the main cause of peptic ulcers includes infection with the bacterium Helicobacter pylori (H. pylori) and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Lifestyle factors may also be considered in understanding the causes of ulcers. For instance, factors such as spicy foods, stress, and alcohol cause stomach ulcers. In this case, such factors may make peptic ulcer symptoms worse (zou et al., 2019). It is thought that smoking increases a patient's risk of developing stomach ulcers and may make treatment less effective. It is also important to note that the pain caused by a stomach ulcer may also result in back pains. Reference Zou, J.-B., Zhang, X.-F., Shi, Y.-J., Tai, J., Wang, Y., Liang, Y.-L., Wang, F., Cheng, J.-X., Wang, J., & Guo, D.-Y. (2019). Therapeutic efficacy of kangfuxin liquid combined with ppis in gastric ulcer. Evidence-Based Complementary and Alternative Medicine, 2019 , 1–13. https://doi.org/10.1155/2019/1324969 . Response 7
During assessment, checking on the signs and symptoms of peptic ulcers and performing an abdominal exam is important. This allows the provider to come up with a conclusive diagnosis based on factors such as symptoms, diagnostics, and medical history. It is; therefore, it is essential to follow the prescribed treatment plan and attend regular follow-up appointments to monitor the healing process and manage any complications. If left untreated, peptic ulcers may result in numerous complications, including internal bleeding, perforation, and obstruction. The first lien of treatment for peptic ulcers includes PPIs. PPIs work by reducing the amount of acid the stomach produces, preventing further damage to the ulcer as it heals naturally (Xie et al., 2022). They are usually prescribed for 4 to 8 weeks. The PPIs most commonly used to treat stomach ulcers are Omeprazole, pantoprazole, and lansoprazole. Reference Xie, X., Ren, K., Zhou, Z. et al. (2022). The global, regional and national burden of peptic ulcer disease from 1990 to 2019: a population-based study. BMC Gastroenterol 22 , 58. https://doi.org/10.1186/s12876-022-02130-2 . Response 8 Considering the patient's diagnosis of peptic ulcers, it is important to develop a treatment plan tailored to the patient's needs. This plan should also include a patient education plan as well as non-pharmacological interventions for the patient's condition. In this case, the patient should be started on antibiotics for two weeks and additional medications to reduce stomach acid, including a proton pump inhibitor and possibly bismuth subsalicylate, Pepto-Bismol (Assefa et al., 2022). Furthermore, medications that block acid production and promote healing. Study shows that the fastest way to promote recovery is to adhere to the treatment plan, which includes
a course of antibiotics and PPIs, while making some lifestyle changes that may help relieve the symptoms sooner and lower your risk of getting another stomach ulcer in the future. Reference Assefa, B., Tadesse, A., Abay, Z. et al.(2022) Peptic ulcer disease among dyspeptic patients at endoscopy unit, University of Gondar hospital, Northwest Ethiopia. BMC Gastroenterol 22 , 164. https://doi.org/10.1186/s12876-022-02245-6 .
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