Duodenal Ulcers
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DUODENAL ULCER 1.
CHIEF COMPLAINT
2.
a. Duodenal ulcer HPI
3.
ROS
4.
SYMPTOMS •Epigastric pain •Feeling of hunger •Bloating •Belching •Melena •Hematemesis
5.
HISTORY •FAMILY HISTORY o Diabetes o Hypertension •SOCIAL HISTORY o Smoking o Alcohol o Caffeine intake •PAST MEDICAL HISTORY o Zollinger-Ellison syndrome [ZES]) o Systemic mastocytosis o Basophilia •SURGICAL HISTORY •CHRONIC CONDITIONS o Zollinger-Ellison syndrome [ZES])
6.
ALLERGIES
7.
PHYSICAL EXAMINATION
•Tenderness over the epigastrium, right upper quadrant
(RUQ), left upper quadrant (LUQ), or supraumbilical region. •Upper abdominal distention •Succussion splash on auscultation 8.
SPECIFIC DATA LIKE GRADING
9.
TESTS TO BE ORDERED •CBP •Serum Amylase •Serum Lipase •Liver function tests (LFTs) •X-ray •USG Abdomen •CT scan •Urea breath test •Fecal antigen test •Barium radiography •The rapid urease test •Endoscopy •Esophagogastroduodenoscopy (EGD)
10. ASSESSMENT /PLAN
Medical Care •Discontinuation of NSAIDs is paramount if it is clinically feasible. Surgical Care •Endoscopic therapy •Vagotomy 11. EDUCATION 12. MEDICATION •Omeprazole •Pantoprazole •Lansoprazole •Esomeprazole magnesium •Famotidine •Nizatidine •Ranitidine
•Ranitidine bismuth citrate •Cimetidine •Amoxicillin •Metronidazole •Tetracycline •Clarithromycin •Bismuth subsalicylate 13. FOLLOW UP
CHIEF COMPLAINT
2.
a. Duodenal ulcer HPI
3.
ROS
4.
SYMPTOMS •Epigastric pain •Feeling of hunger •Bloating •Belching •Melena •Hematemesis
5.
HISTORY •FAMILY HISTORY o Diabetes o Hypertension •SOCIAL HISTORY o Smoking o Alcohol o Caffeine intake •PAST MEDICAL HISTORY o Zollinger-Ellison syndrome [ZES]) o Systemic mastocytosis o Basophilia •SURGICAL HISTORY •CHRONIC CONDITIONS o Zollinger-Ellison syndrome [ZES])
6.
ALLERGIES
7.
PHYSICAL EXAMINATION
•Tenderness over the epigastrium, right upper quadrant
(RUQ), left upper quadrant (LUQ), or supraumbilical region. •Upper abdominal distention •Succussion splash on auscultation 8.
SPECIFIC DATA LIKE GRADING
9.
TESTS TO BE ORDERED •CBP •Serum Amylase •Serum Lipase •Liver function tests (LFTs) •X-ray •USG Abdomen •CT scan •Urea breath test •Fecal antigen test •Barium radiography •The rapid urease test •Endoscopy •Esophagogastroduodenoscopy (EGD)
10. ASSESSMENT /PLAN
Medical Care •Discontinuation of NSAIDs is paramount if it is clinically feasible. Surgical Care •Endoscopic therapy •Vagotomy 11. EDUCATION 12. MEDICATION •Omeprazole •Pantoprazole •Lansoprazole •Esomeprazole magnesium •Famotidine •Nizatidine •Ranitidine
•Ranitidine bismuth citrate •Cimetidine •Amoxicillin •Metronidazole •Tetracycline •Clarithromycin •Bismuth subsalicylate 13. FOLLOW UP
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