A 45-year-old male was admitted with complaints of giddiness, recurrent loss of consciousness, blood in vomiting, and stomach pain. Endoscopy revealed a large duodenal ulcer. He was diagnosed with peptic ulcer disease and treated with pantoprazole, ceftriaxone, sucralfate, vitamins, and a triple therapy regimen to eradicate H. pylori. The patient was counseled on medication administration, completing treatment, and reporting any alarming symptoms.

1. Case presentation on peptic ulcer
disease
Presented by :
METI.BHARATH KUMAR
16DK1T0014
Pharm-D(Intern)

2. Demographics
• Name :xyz
• Age :45 yrs
• Sex:male
• Admission No:65876
• Department : general medicine
unit : mm-7
• Date of admission :1-12-2021
• Consultant physician: Dr Maheswara Reddy

3. Subjective evidence
• A 45yrs old male patient admitted to male
medical ward with complaints of –
c/o giddiness since 2 days
c/o recurrent loss of consciousness since 1 day
c/o blood in vomiting ( haematemesis)
c/o of headache associated with stomach
pain
Past history : nothing significant

4. Objective evidence
• UGI Endoscopy:
impression: large ulcer noted in the
duodenum
• CBP: shows decreased haemoglobin

5. Assessment
• Based on subjective and objective evidences
the current condition is diagnosed as peptic
ulcer disease.

6. Planning
vitals
• Bp :100/70 mmhg
On examination patient is
conscious and coherent
• PR:96
• RR:20
Systemic examination
• Cvs : s1 s2 +
• RS: BAE +
• CNS : NFND
Treatment
• Inj pantop 80mg in 100ml
NS
inj pantop 40mg iv BD
• Inj ceftriaxone 1g iv bd
• Tab IFA po bd
• Tab B complex OD
• Inj trenaxemic acid
500mg iv sos
• HP Kit
Omeprazole20mg+tinidazole500mg+
amoxycillin750mg

7. vitals
• Bp :90/70 mmhg
On examination patient is
conscious and coherent
• PR:100
• RR:18
Systemic examination
• Cvs : s1 s2 +
• RS: BAE +
• CNS : NFND
treatment
• Inj pantop 80mg in 100ml
NS
inj pantop 40mg iv BD
• Inj ceftriaxone 1g iv bd
• Tab IFA po bd
• Tab B complex OD
• Inj trenaxemic acid
500mg iv sos
• HP Kit
Omeprazole20mg+tinidazole500mg+
amoxycillin750mg

8. vitals
• Bp :90/60 mmhg
On examination patient is
conscious and coherent
• PR:96
• RR:20
Systemic examination
• Cvs : s1 s2 +
• RS: BAE +
• CNS : NFND
• Tab pantop 40mg od
• Syp sucralfate 10ml po bd
• Tab IFA bd
• Tab Bcomplex OD
• Inj eldervit in 1NS iv od
• Plan for blood transfusion
• Hp kit
Omeprazole20mg+tinidazole500mg+
amoxycillin750mg

9. Drug chart
S.
NO
Generic name bran
d
Indication Dose ROA Freque
ncy
1 ceftriaxone To reduce
infection
1g iv BD
2 pantoprazole pant
op
To reduce gi
irritation
40mg Iv OD
3 Trenaxemic
acid
To stop bleeding 500m
g
iv Sos
4 B complex Vitamin
supplement
500m
g
oral Od
5 Iron folic acid Mineral
supplement
oral Bd
6 sucralfate protect ulcer
from injury
1g/1
0ml
oral bd
7 Folic
acid+methylco
balamin+vit
c+niacinamide
elde
rvit
Prevent
nutritional
deficiencies
1
amp
iv Od

10. Pharmaceutical care issues
• No pharmaceutical care issues

11. Discussion
Peptic ulcer disease refers to painful sores or ulcers
in the lining of the stomach or the first part of the
small intestine, the duodenum.
Acid related diseases(gastritis,erosionsand PUD)of
the UGIT require gastric acid for their
formation.PUD differ from gastritis and erosions in
that ulcers typically extend deeper into the
muscularis mucosa.There are 3 common forms of
peptic ulcers –NSAID Induced
--h.pylori
--stress induced

13. Etiology

14. Clinical manifestations
• Abdominal pain is the most frequent dyspeptic
symptom of both DU and PU.
• The pain often epigastric and described as
burning .
DUODENAL ULCER
• Many patients with DU describe a typical
nocturnal pain that awakens them from sleep
(especially between 12am and 3am)
• This ulcer related pain usually starts 1 to 3hrs
after meals and usually relieved by food

15. GASRTIC ULCER
In gastric ulcer food may precipitate ulcer related pain.
antacids provide relief in most of the ulcers .The
abdominal pain usually deminishes or disappear during
treatment;however reoccrance of pain suggests unhealed
ulcer.
Dyspeptic symptoms
heatburn,belching and bloating
Nausea,vomiting,anorexia and weight loss

18. Treatment

21. Patient counselling
• Providing patient education
1.cause:explain that ulcer is caused by bacteria/NSAIDs
induced
2.treatment:explain that treatment consists of antibiotics
and antiulcermedication
3.administration:instruct the patient on when and how to
take medication
4.adverse effects:counsel the patients to report intolerable
effects
5.complete treatment :advice the patient to complete
treatment even he is better
6.compliance:explain the importance of compliance to the
drug treatment regimen

22. 7.Alarm symptoms: instruct the patient to report
bleeding,vomiting and abdominal pain People who
smoke cigarettes are more likely than nonsmokers to
develop peptic ulcers.
8.While drinking alcohol does not appear to be a
cause of ulcers, alcohol abuse can interfere with ulcer
healing.
9.Although certain foods and beverages can cause
stomach upset, there is no good evidence that they
cause or worsen ulcers. Still, eating a healthy diet
with plenty of fruits, vegetables, and fiber may
decrease the risk of ulcers.

23. • The role of psychological stress in the formation
of ulcers is controversial. There is some evidence
that psychological factors (such as stress, anxiety,
and depression) may contribute to the
development of ulcers as well as impaired healing
and increased recurrence. However, this
relationship is not fully understood, as there are
many other variables involved (eg, the presence
or absence of H. pylori; use of NSAIDS; other
individual characteristics) and "stress" can be
difficult to measure and study.