1. A 55-year-old man presents with epigastric abdominal pain, dark stool, and dizziness. Endoscopy shows multiple gastric ulcers. He takes NSAIDs and has a family history of peptic ulcer disease. 2. His treatment plan includes stopping NSAIDs and antacids, starting omeprazole 20mg twice daily, monitoring for symptoms and complications, and patient education on lifestyle changes and medication adherence. 3. Follow up in 2-4 weeks includes repeat endoscopy in 6-8 weeks to confirm ulcer healing before tapering medications to prevent recurrence.

1. Nsaid Induced Duodenal
ulcer
#1
Done By : Aya kamel Ali

2. SOAP Note
Subjective :
He complains of epigasteric abdominal
pain , vague abdominal discomfort and
dizziness
He noticed darkening of stool one week
ago
the pain come between 1-3 am and
relived by food He describes it of being
moderately to severe

3. SOAP Note

Subjective , cont

Endoscopy shows multiple gastric ulcer

Manager of stressful job


His father died at age of 59 of shock due to
severe GI bleeding 2ry to untreated PUD

4. SOAP Note
Objective :
 Hgb 11.0 mg/dL
 Hct 33
 Abd : Mild tenderness , no masses
 Rect : Non-tender ; melenic stool found in
rectal valut ; stool heme +ve
 Endoscopy shows multiple gastric ulcer .


5. Risk factors :





Nsaid use (ibuprofen)
Age
Smoking
Family history
Stress

6. Assessment

DRP
Indication (Needs
additional drug therapy )
Untreated condition
A.S 55 year-old African-American male who
suffers from epigastric abdominal pain 1 year
ago which not relieved by using OTC antacid
(Maalox & Bismuth subsalicylate ) needs
additional drug therapy

7. 
DRP ,,, cont
Safety (adverse drug
reaction )
Undesirable effect
A.S 55 year-old African-American male who
takes OTC bisthmus subsalicylate for
epigasteric abdominal pain , but his condition
become worse and develops bleeding as a
side effect which increase risk of recuurance
. he needs to stop using it .

9. Therapeutic goal
Short term goal :
 Prevent complication (perforation , penetration
, obstruction , malignancy
 promote ulcer healing Stop the ulcer bleeding
 Symptomatic relive .

10. Long term goals :


Preventing recurrence and avoiding potential
complications.
Reduce financial cost of treatment .

12. Blatchford score
According to blatchford score
Patient has high risk of
bleeding


13. Pharmacological intervention :

Stop using ibuprofen to prevent further
complication

Stop using bismuth subsalicylate to
minimize the risk of bleeding .

14. Cont …



Add omeprazole 2o mg Bid
Brand name : Gasec by mepha company
Price 27 SR

15. Alternatives


Ranitidine double dose 300 mg q.i.d
Endoscopy treatment

16. Non pharmacological
intervention





Omega -3 fatty acids has anti-inflamatory
effect help to protect the stomach from ulcers
Acupuncture treatments .
Endoscopy treatment .
Injection therapy .
Yoga practice to manage stress

17. Monitoring

Efficacy

Symptomatic improvement.

Safety

The appearance of adverse events like :
muscle cramps, muscle weakness or limp
feeling; seizures


18. Monitoring
Testing for H.pylori
 Patients taking the test should stop taking
PPIs for at least 2 weeks (they interfere with
the test) and starve for 4 hours before.
 Fecal Occult Blood Test
CBC & Hemoglobin


19. Follow up
•
•



Assess the adherence.
Assess the signs and symptoms of progression of
ulcer
Follow up session should be scheduled 2-4
weeks after initiating the therapy.
repeat endoscopy to confirm healing at 6 to 8
weeks.
If ulcer healed decrease omeprazole dose
gradually to maintenance dose to prevent
recurrence.

20. Patient education :






Take omeprazole 1 hour before meals .
Avoid spicy food and xanthin containing
beverage and , drinks containing caffeine.
Avoid heavy meals before bed time
Smoking increases the amount of acid
produced by the stomach . need smoking
cessation plan .
Encourage small frequent low caloric meals
Avoid ulcerating drug e.g. NSAIDs
,Corticosteroid.