NBSN2106
Patho-Pharm II
GI Case Study
Group Member Names:
Riley Hanger
Abby Harlan
Anthony, a 48-year-old business executive is brought to the emergency department by a co-
worker. At work he started vomiting a large amount of coffee-ground emesis and requested to
go to the hospital. Anthony has a 9-year history of PUD and was hospitalized with upper GI
bleeding 4 years ago. At that time, specimens obtained via fiberoptic endoscopy were positive
for H. pylori, so he was treated with triple antibiotic therapy. His PUD has been controlled with
medications since that time, but he states he has recently been under much more stress than
usual because of company merger negotiations. He started smoking again after having quit for
7 years, and his alcohol consumption in the last 3 months has increased, especially when
meeting with other business executives. Because of his work demands, he has not taken his
medications routinely, eaten a healthy diet, or slept well. He has a chronic, intermittent
headaches. He has been careful not to use aspirin, instead taking ibuprofen for headache relief.
He reports that he has had increasingly dark stools for the past week and developed severe
nausea before he started vomiting this morning. He says he has no sharp pain, only mild upper
abdominal discomfort and nausea.
Your initial assessment reveals the following vital signs: BP 102/62 mm Hg, heart rate (HR) 98
beats/min, respiratory rate (RR) 24 breaths/min, temperature 98.0° F (36.7° C); capillary refill at
4 sec; skin cool and slightly moist, no distention of jugular veins, clear lung sounds, and a soft
abdomen with hyperactive bowel sounds.
1. Give one example of the medications used in triple therapy for H. pylori, including the
classifications of the medications.
Amoxicillin, antibiotics
2. List at least 5 risk factors for PUD, and identify which ones Anthony has.
Overuse of NSAIDs, cigarette smoking, helicobacter pylori infection, steroids, GERD Anthony has
a history of helicobacter pylori infection and is a smoker.
3. You assess Anthony for clinical manifestations and distinguishing characteristics
associated with gastric and duodenal ulcers. Match the manifestations or characteristics
to the correct type of ulcer.
Symptom Duodenal Gastric
Aggravation of discomfort with food x
Associated with increased gastric acid secretion x
More likely to result in GI tract obstruction x
This study source was downloaded by 100000806176105 from CourseHero.com on 02-02-2022 06:30:04 GMT -06:00
https://www.coursehero.com/file/57059722/Patho-Pharm-GI-Case-Studydocx/
, Associated with Zollinger-Ellison syndrome x
Burning or cramping pain across midepigastric region x
Burning or gaseous pain high in left epigastric region x
Higher mortality rate when perforation occurs x
Associated with an increased cancer risk x
Pain occurring 2 to 5 hours after meals x
Pain relieved with antacids and food x
As you finish Anthony's assessment, he vomits 460 mL of dark, coffee-ground appearing emesis.
The emesis tests positive for blood.
4. What is the term for blood in emesis?
Hematemesis
5. You recognize that the appearance of this vomitus results from:
a. blood being changed by gastric secretions.
b. fresh, capillary bleeding in the stomach.
c. the mixing of blood and fecal contents.
d. the presence of bile from the small intestine.
6. Anthony is admitted and undergoes fiberoptic endoscopy to directly visualize the
bleeding site and allow the use of electrocoagulation to stop the bleeding. A bleeding
ulcer on the posterior aspect of the duodenum is found and coagulated. When he
returns to the unit, the health care provider places new orders. Match the correct
rationale to each identified order.
__b__ Decreases acid secretion a. Hourly urine output
__d__ Evaluation of blood loss b. Esomeprazole 80 mg IV
now
__c__ Evaluation of drug efficacy c. Assess pH of gastric
contents every 8 hr
__a__ Evaluation of fluid replacement d. Hgb and Hct every 6 hr
__e__ Protect gastric mucosa from acid e. Sucralfate 1 g every 6 hr
secretion via NG tube
7. Anthony’s bleeding is controlled with treatment. His lowest Hgb and Hct, which
occurred 24 hours after admission, was 11.5 g/dL (115 g/L) and 32%. The health care
provider withheld replacement with blood products. His gastric tissue biopsy returns
positive for H. pylori infection. Two days after the endoscopy his NG tube is removed
and oral intake is started. In reviewing Anthony’s diet with him, you evaluate that he
understands the recommendations for dietary management in PUD when he says:
This study source was downloaded by 100000806176105 from CourseHero.com on 02-02-2022 06:30:04 GMT -06:00
https://www.coursehero.com/file/57059722/Patho-Pharm-GI-Case-Studydocx/
Patho-Pharm II
GI Case Study
Group Member Names:
Riley Hanger
Abby Harlan
Anthony, a 48-year-old business executive is brought to the emergency department by a co-
worker. At work he started vomiting a large amount of coffee-ground emesis and requested to
go to the hospital. Anthony has a 9-year history of PUD and was hospitalized with upper GI
bleeding 4 years ago. At that time, specimens obtained via fiberoptic endoscopy were positive
for H. pylori, so he was treated with triple antibiotic therapy. His PUD has been controlled with
medications since that time, but he states he has recently been under much more stress than
usual because of company merger negotiations. He started smoking again after having quit for
7 years, and his alcohol consumption in the last 3 months has increased, especially when
meeting with other business executives. Because of his work demands, he has not taken his
medications routinely, eaten a healthy diet, or slept well. He has a chronic, intermittent
headaches. He has been careful not to use aspirin, instead taking ibuprofen for headache relief.
He reports that he has had increasingly dark stools for the past week and developed severe
nausea before he started vomiting this morning. He says he has no sharp pain, only mild upper
abdominal discomfort and nausea.
Your initial assessment reveals the following vital signs: BP 102/62 mm Hg, heart rate (HR) 98
beats/min, respiratory rate (RR) 24 breaths/min, temperature 98.0° F (36.7° C); capillary refill at
4 sec; skin cool and slightly moist, no distention of jugular veins, clear lung sounds, and a soft
abdomen with hyperactive bowel sounds.
1. Give one example of the medications used in triple therapy for H. pylori, including the
classifications of the medications.
Amoxicillin, antibiotics
2. List at least 5 risk factors for PUD, and identify which ones Anthony has.
Overuse of NSAIDs, cigarette smoking, helicobacter pylori infection, steroids, GERD Anthony has
a history of helicobacter pylori infection and is a smoker.
3. You assess Anthony for clinical manifestations and distinguishing characteristics
associated with gastric and duodenal ulcers. Match the manifestations or characteristics
to the correct type of ulcer.
Symptom Duodenal Gastric
Aggravation of discomfort with food x
Associated with increased gastric acid secretion x
More likely to result in GI tract obstruction x
This study source was downloaded by 100000806176105 from CourseHero.com on 02-02-2022 06:30:04 GMT -06:00
https://www.coursehero.com/file/57059722/Patho-Pharm-GI-Case-Studydocx/
, Associated with Zollinger-Ellison syndrome x
Burning or cramping pain across midepigastric region x
Burning or gaseous pain high in left epigastric region x
Higher mortality rate when perforation occurs x
Associated with an increased cancer risk x
Pain occurring 2 to 5 hours after meals x
Pain relieved with antacids and food x
As you finish Anthony's assessment, he vomits 460 mL of dark, coffee-ground appearing emesis.
The emesis tests positive for blood.
4. What is the term for blood in emesis?
Hematemesis
5. You recognize that the appearance of this vomitus results from:
a. blood being changed by gastric secretions.
b. fresh, capillary bleeding in the stomach.
c. the mixing of blood and fecal contents.
d. the presence of bile from the small intestine.
6. Anthony is admitted and undergoes fiberoptic endoscopy to directly visualize the
bleeding site and allow the use of electrocoagulation to stop the bleeding. A bleeding
ulcer on the posterior aspect of the duodenum is found and coagulated. When he
returns to the unit, the health care provider places new orders. Match the correct
rationale to each identified order.
__b__ Decreases acid secretion a. Hourly urine output
__d__ Evaluation of blood loss b. Esomeprazole 80 mg IV
now
__c__ Evaluation of drug efficacy c. Assess pH of gastric
contents every 8 hr
__a__ Evaluation of fluid replacement d. Hgb and Hct every 6 hr
__e__ Protect gastric mucosa from acid e. Sucralfate 1 g every 6 hr
secretion via NG tube
7. Anthony’s bleeding is controlled with treatment. His lowest Hgb and Hct, which
occurred 24 hours after admission, was 11.5 g/dL (115 g/L) and 32%. The health care
provider withheld replacement with blood products. His gastric tissue biopsy returns
positive for H. pylori infection. Two days after the endoscopy his NG tube is removed
and oral intake is started. In reviewing Anthony’s diet with him, you evaluate that he
understands the recommendations for dietary management in PUD when he says:
This study source was downloaded by 100000806176105 from CourseHero.com on 02-02-2022 06:30:04 GMT -06:00
https://www.coursehero.com/file/57059722/Patho-Pharm-GI-Case-Studydocx/
