Case Study: Peptic Ulcer Disease

Case Study: Peptic Ulcer Disease

Fayetteville State University

NURS 325-Pathophysiology, Spring Semester

April 20, 2011

Abstract

This document will identify the normal structure, function, and variations of the gastrointestinal system, as it relates to this case study of peptic ulcer disease. By incorporating the discussion of the developmental process of gastric secretion in the diagnosis of peptic ulcer disease, the nurse will focus on the plan of care by use of assessment, interventions, plan, and evaluation.

Dr. S is a 55-year-old male professor whose department chair is an unrelenting harasser. Dr. S’s family investments have failed, and his early planned retirement is no longer possible. Persistent upper abdominal pain for the last 2 months has convinced him that he needs a diagnostic work-up. Dr. S reveals a history of smoking one pack of cigarettes a day. His eating habits are irregular. However, he indicates a pain-antacid-relief pattern. The pain is more intense right after eating. He often takes aspirin for headaches and to relieve rheumatoid stiffness while golfing. His family and remaining history are unremarkable except that he has lost 10 pounds during the last 6 weeks.

ORDER Case Study: Peptic Ulcer Disease

Case Study: Peptic Ulcer Disease

The case study deliberates about Dr. S., a male in the middle adulthood period of the life cycle (Jarvis, 2008), with complaints of persistent upper abdominal pain for the last two months, now seeking medical advice. He reveals a history of smoking, irregular eating habits, more intense pain immediately after eating, a pain-antacid-relief pattern, recent weight loss, and the use of aspirin for pain relief of headaches and rheumatoid stiffness. Family history is unremarkable.

Based on these symptoms presented, it appears this patient has a gastric ulcer, a type of peptic ulcer disease, which is a gastrointestinal disorder. By incorporating the discussion of the developmental process of the digestive system and its effects in the diagnosis of peptic ulcer disease, focus will include a plan of care by use of assessment, interventions, plan, and evaluation.

Normal Function and Structure of the Gastrointestinal System

The gastrointestinal system is comprised of the mouth, esophagus, stomach, small and large intestine, rectum and anus. This process includes food ingestion, peristalsis, mechanical and chemical breakdown, captivation of nutrients, and evacuation of waste products. After food mixed with saliva activates carbohydrate breakdown, it reaches the end of the esophagus, and enters the stomach through a muscular valve called the lower esophageal sphincter. This sphincter prevents stomach regurgitation which may cause corrosive damage to the esophagus (Huether and McCance, 2008).

The stomach is a hollow, muscular organ, located on the left side of the upper abdomen. Three functional areas of the stomach include the fundus (upper portion), body (middle portion), and antrum (lower portion). The stomach accumulates food after mastication, secreting digestive acidic fluids and enzymes and mixes food with these digestive acidic fluids and enzymes. Digestive fluids consist of an acid that liquefies food, kills microorganisms, and transforms pepsinogen to pepsin, pepsin that breaks down protein, mucus that protects stomach mucosa, intrinsic factor that is needed for B12 absorption and gastroferrin that is needed for iron absorption in the small intestine. Crests of muscle tissue called rugae line the stomach (Huether and McCance, 2008).

The stomach has a rich arterial and venous blood supply and is supplied by both the sympathetic and parasympathetic divisions of the autonomic nervous system. Stimulation of the sympathetic response causes peristaltic reduction and stimulation of the parasympathetic response causes increased motility and secreted gastric juices. Gastric motility is influenced by enteric hormones such as gastrin (gastric acid secretion aid) and cholecystokinin (pancreatic enzymes and bile secretion stimulator), which acts to relax the proximal stomach and enhance contractions in the distal stomach. The stomach muscles contract periodically, and by peristaltic wave action, partially digest food into a thick semifluid mass of partially digested food called chyme. Chyme then passes through the pyloric sphincter, another muscular valve that opens, allowing food to pass from end to end through the pylorus, (via osmotic pressure) the duodenum, and into the small intestine, where nutrients are absorbed (Huether and McCance, 2008).

The small intestine is comprised of the duodenum absorbing iron, calcium, fats, sugars, water, proteins, vitamins, magnesium, and protein, the jejunum absorbing sugars and proteins and the ileum absorbing bile salts, vitamin B12 and chloride (Huether and McCance, 2008).good

Dysfunctions of the Gastrointestinal System

Peptic ulcer disease affects mostly the stomach and duodenum. However, when gastric acids become altered, ulcerations of the mucosal lining occur, and may affect the lower

esophagus, the stomach and duodenum in peptic ulcer disease. Erosion of the outer smooth muscle layer begins and ulcerations can extend into the inner smooth muscle layer. This damage can cause blood vessels to hemorrhage or the gastric wall to perforate, which can be life threatening (Huether and McCance, 2008).