Patient X, a 58-year-old grocery store manager, was experiencing abdominal pain several nights a week and occasional discomfort in the afternoon. An endoscopy revealed a peptic ulcer and infection with Helicobacter pylori bacteria. He was prescribed medication to reduce stomach acid and instructed to return for another endoscopy in 6 months. Peptic ulcer disease is common in the Philippines and a leading cause of death, especially among those with poor lifestyles. The duodenum is responsible for digesting food using enzymes secreted by the pancreas and bile from the liver and gallbladder.

1. I. Introduction
a. Background Study
Peptic Ulcer Disease is an ulcer (defined as mucosal erosions equal to or greater than 0.5
cm) of an area of the gastrointestinal tract that is usually acidic and thus extremely painful.
Patient X, a fifty-eight year old grocery store manager, had recently been waking up in
the middle of the night with abdominal pain. This was happening several nights a week. He was
also experiencing occasional discomfort in the middle of the afternoon. Patient X decided to
schedule an appointment with his physician on June 21, 2014.
The doctor listened as Patient X described his symptoms and then asked Patient X some
questions. He noted that patients’ appetite had suffered as a result of the pain he was
experiencing and as a result of the fear that what he was eating may be responsible for the pain.
Otherwise, Patient X seemed fine.
The doctor referred Patient X to a physician that specialized in internal medicine and had
patient make an appointment on June 24 for a procedure called an endoscopy. The endoscopy
was performed at a hospital later that week. During the procedure, a long, thin tube was inserted
into patient’s mouth and directed into his digestive tract. The end of the tube was equipped with
a light source and a small camera which allowed the doctor to observe the interior of patient’s
stomach. The endoscope was also equipped with a small claw-like structure that the doctor could
use in order to obtain a small tissue sample from the lining of patient’s stomach.
The endoscopy revealed that patient had a peptic ulcer. Analysis of a tissue sample taken
from the site showed that patient’s also had an infection that was caused by Helicobacter
pylori bacteria. The doctor who performed the endoscopy gave patient’s prescriptions for
medication that would decrease the secretion of stomach acid such as, Omeprazole and
Ranitidine. The doctor also instructed patient to schedule an appointment for another endoscopy
procedure in 6 months.
According to the latest WHO data published in April 2011 Peptic Ulcer Disease Deaths
in Philippines reached 7,423 or 1.76% of total deaths. The age adjusted death rate is 14.83 per
100,000 of population ranks Philippines #2 in the world and it is most common in middle age to
elderly especially for those who have poor lifestyle.
(http://www.worldlifeexpectancy.com/philippines)

2. b. Objectives:
GeneralObjectives:
At the end of study, we will be able todeveloped new knowledge and improve our skills
in handling patients suffers from this disease. We also able to provide proper and quality nursing
care for our patient.
Specific Objectives:
 To developed new knowledge about the disease.
 To know the underlying cause of the disease.
 To know the Effects of diseased to individuals.
 To know the preventive measures of having duodenal ulcer.
 To determine the factors that affects the disease.
 To enhance our ability in caring patient with this disease.
 To provide proper interventions to specific symptoms occurs to patient.
 To improve learning process through values enhancement.
 To prevent the factors that risk for this disease.

3. c. Anatomy and Physiology
The intestines are a long, continuous tube running from the stomach to the anus. Most
absorption of nutrients and water happen in the intestines. The intestines include the small
intestine, large intestine, and rectum.
The small intestine (small bowel) lies between the stomach and the large intestine (large
bowel) and includes the duodenum, jejunum, and ileum. The small intestine is so called because
its lumen diameter is smaller than that of the large intestine, although it is longer in length than
the large intestine.
The duodenum is the most proximal portion of the small intestine. Its name is derived
from the latin ‘duodenum digit run’, meaning twelve fingers width. It runs from the pylorus to
the duodenojejunal junction. Anatomically, we can divide the duodenum into four parts;
superior, descending, inferior and ascending. Together, these parts form a ‘C’ shaped structure,
which wraps around the head of the pancreas.
The duodenum is largely responsible for the breakdown of food in the small intestine,
using enzymes. The villi of the duodenum have a leafy-looking appearance, which is a
histologically identifiable structure. Brunner's glands, which secrete mucus, are found in the
duodenum only. The duodenum wall is composed of a very thin layer of cells that form the
muscularis mucosae. The duodenum is almost entirely retroperitoneal. It has three parts and each
part has its own significance.
The duodenum also regulates the rate of emptying of the stomach via hormonal
pathways. Secretin and cholecystokinin are released from cells in the duodenal epithelium in
response to acidic and fatty stimuli present there when the pylorus opens and releases gastric
chyme into the duodenum for further digestion. These cause the liver and gall bladder to release
bile, and the pancreas to release bicarbonate and digestive enzymes such as trypsin, lipase and
amylase into the duodenum as they are needed.
(Reference: http://www.hopkinsmedicine.org)

4. II. Biographic data
a. Patients’ Profile
Name: Patient X
Address: Blk. 3 Lot. 4, FVR NorzagarayBulacan
Age: 58yrs
Gender: Male
Civil Status: Married
Educational Level: High school Graduate
Religion Affiliations: Catholic
Occupation: Grocery Store manager
Provisional Diagnosis: Peptic Ulcer
Final Diagnosis: Duodenal Ulcer
Chief Complaint:“apat na araw nangsumasakityungtiyanko, parangsinusunog
lalonasatuwing pag lipas ng isa hangang dalawang oras
Pagtaposkokumain”
b. Past History illness
Patient had Chicken Pox when he was 7 yrs. of age. He also had taken Multivitamins daily.
He takes cigarettes and consumes 1 pack a day for 37 years.
c. Present History illness
Prior to admission, the patient experiencing abdominal pain, nausea & vomiting,and
dizziness especially after eating his meal. He also suffers from sleep disturbance due to abdominal
pain.
d. Immunization
Patient was completed to receivehis vaccines such as, BCG, DPT, OPV, Hepa.B and
measles.He also receives annual influenza vaccine.
e. Family History
Alcoholic Uterine Ca Prostate Ca Osteoporosis
Female deceased Cirrhosis
Duodenal Ulcer A & W
Female
A&W A&W A&W
Male deceased
Male
Ca- Cancer
A&W- alive & well
51 49
23
58 56
63
18
75
16
X
X