Surgery

1. PRESENTED BY:
MAKBUL HUSSAIN CHOWDHURY
15Z11T0006
Pharm.D 5th YEAR

2. DEFINITION:
A crater(ulcer) in the lining of the beginning of the
small intestine (duodenum).
CAUSES OF DUODENAL ULCER
 Infection with helicobacter pylori
Anti-inflammatory medicines
Other factors such as smoking, stress and drinking

4. SYMPTOMS OF DUODENAL ULCER
 Pain in the upper tummy(abdomen) just below
the breastbone (sternum)
 Bloating
 Retching
 Feeling sick

5. DIAGNOSIS
• Testing for blood, stool or a sample of tissue from
digestive tract(biopsy) that can be tested for H.pylori
•Endoscopy(upper small intestine to check for an
ulcer)

6. COMPLICATIONS OF DUODENAL ULCER
 Perforation is a much less frequent complication
than bleeding
Use more non-steroidal anti-inflammatory
drugs(NSAIDS),the incidence of perforation is
increasing

7. SUBJECTIVE DATA
PATIENT NAME : Xxx
AGE: 34yrs
GENDER :Female
DEPARTMENT : General medicine
DOA : 23/11/19
CHIEF COMPLAINTS
 3 episodes of hemetemesis since yesterday
 1 episodes of black stools since 2 days

8. PAST HISTORY
Nil
SURGICAL HISTORY
Nil

9. PERSONAL HISTORY
Diet: Mixed(spicy food in take)
Sleep: Normal
Bowel and Bladder : Regular
Appetite: Normal

10. OBJECTIVE DATA
Temperature : Afebrile
Pulse rate : 70bpm
Blood pressure :110/70mm Hg
Respiratory rate : 20/min
CVS: S1S2 
PA: Soft, non-tender.

11. S.N
O
LAB TESTS NORMAL VALUE LAB VALUE
1. Haemoglobin 13.5-17.5gm% 9.6gm% ↓
2 WBC count 4,000-
11,000cells/Mm3
9,900cells/ Mm3
3 Neutrophils 40-80% 66%
4 Lymphocytes 20-40% 24%
5 Eosinophils 01-06% 6%
6 Monocytes 02-10% 4%
7 MCHC 32-36% 41.3% ↑
8 BUN 15-40mg/dl 41mg/dl ↑
9 Sr. Creat 0.5-1.5mg/dl 1.6mg/dl ↑
10 Sodium 135-155mmol/L 132mmol/L ↓

12. SI
NO
LAB TESTS NORMAL VALUE LAB VALUE
11 PCV 33-47% 22.3% ↓
12 potassium 3.5-5.5mmol/lit 4.1mmol/lit

13. ASSESMENT
DUODENAL ULCER

14. THERAPEUTIC GOALS
 To reduce the disease condition
 To prevent further progression the disease.
 To stabilize the patient and to complete initial evaluation
and assessment, including imaging and laboratory
studies.

15. TREATMENT CHART
SI.
N
O
BRAND
NAME
GENERIC
NAME
INDICATION DOSE ROA FREQUE
NCY
1. T.PAN Pantoprazole Acidity 40mg PO BD
2 T.AUTRIN Ferrous
fumarate+Folic
acid+Vit-B12
Vitamin
deficiency
325mg PO OD
3 INJ. LASIX Furosemide Given before
blood
transfusion
1amp IV
4 T.CIPORIC ciprofloxacin Antibacterial
agent
250mg Po OD
5 T.ONDEO-
R
Ondansetron Antiemetic 4mg PO BD

16. PROGRESS
DAY 1
Patient conscious & coherent
TEMP : A febrile
PR:72bpm
BP:120/80mm Hg
Blood vomitings and blood stools
MEDICATION :
Blood transfusion is done in the morning
INJ. PAN,T.AUTRIN,INJ. LASIX(given before blood
transfusion)

17. DAY 2
Patient conscious&coherent
Temp : A febrile
PR:72bpm
Bp:110/70mmHg
No Fresh complaints
MEDICATIONS : CST
DAY 3
NO FRESH COMPLAINTS
BP:110/70mm Hg
PR:88bpm
MEDICATIONS: CST

18. DISCHARGE MEDICATION
1. T.PAN 40MG (BD)
2. T.AUTRIN(OD)
3. T.ONDANSETRON(BD)
4. AMOXICILLIN(BD)

20. PATIENT COUNSELLING
REGARDING DRUGS
TAB. AUTRIN: Should be taken on an empty stomach.Do not
stop the drug untill doctor says to do so
TAB.PAN: One dose should be taken with empty stomach in the
morning and other dose taken at night after meal
Do not crush or chew the tablets

21. LIFE STYLE MODIFICATIONS
 Take high fibre rich food i.e vegetables such as
bottle gaurd,snake guard, peas etc
 Donot eat spicy or acidic foods such as
oranges,pickles etc
 To eat regular meals in a relaxed setting and to
avoid over eating
 NSAIDS are not taken untill doctor prescribed
If any further complications occur consult doctor
immediately