Introduction
The life of most people in the modern world is full of stressful events, leading to an uneven consumption of food and ignorance of health problems. One of the most common conditions experienced by patients today is gastric ulcers. Using the Chandler case as an example, it is necessary to determine the prerequisites for the onset of the disease and what preventive measures exist to avoid such consequences.
Pathophysiology of Gastric Ulcer
A gastric ulcer is a breach in the mucosal integrity of the stomach lining. It can be damaged by excessive consumption of caffeine, alcohol, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin (Woolf et al., 2022). Gastric ulcers can appear due to Helicobacter pylori bacteria infestation (Jenkins, 2021). The bacteria stimulate increased acid production, weakening and gradually destroying mucosal cells (Feldman et al., 2020). Meanwhile, NSAIDS are acid in nature and can linger in the epithelial cells of the stomach, increasing their permeability and resulting in cellular injury (Woolf et al., 2022). The weakened lining leads to gastric acid and pepsin enzymes leaking into the stomach, further destroying the protective mucosa and leading to bleeding and ulceration (Jenkins, 2021). The formed ulcers can be further exacerbated by food intake, with patients experiencing severe pain due to ulcer aggravation.
Focused Gastrointestinal Assessment
Chief Complaint
The patient, a 47-year-old male, presented to the hospital complaining of mid-epigastric pain, bloating, and nausea following meals. Moreover, the patient noticed a change in the color of his stool in the last two days. Upon admittance, subjective and objective data were collected, including the history of medication use, data on recent surgeries and other treatments, lifestyle, and nutritional-metabolic information. A physical examination of the patient’s abdominal area was performed.
Medication History
The patient under consideration suffers from ulcers and headaches, evidenced by his aspirin intake. The headache is not constant but periodic, which indicates an unstable state of health. Due to a sprained ankle, the patient took ibuprofen for three weeks, leading to the concentration of the active element of drugs in the body, adversely affecting the alimentary tract’s state (Shiotani, 2018). The drug is toxic to the mucous membrane and can cause bleeding of an ulcerative or hemorrhoidal character (Bokelmann, 2021). Overall, Chandler’s medications adversely affect the mucous membrane of the stomach and digestive tract. Although the adverse effects of ibuprofen have been described above, the harmfulness of aspirin should be noted (Roesler, 2019). The drug is designed to suppress the production of enzymes in the body to relieve many symptoms as a painkiller (Cardoso et al., 2018). Suppression of the activity of cyclooxygenases has a negative effect since they are responsible for normal gastric mucosa cells functioning.
Current Lifestyle and Diet
The patient’s lifestyle, diet, and habits should be taken into consideration. One should emphasize the severity and stressfulness of Chandler’s work, where he spends most of his time (Bokelmann, 2021). The description of the work of an accountant allows concluding that food intake is uneven, and there are frequent cases of starvation and overeating. The patient’s constant consumption of coffee in large quantities is emphasized (Bokelmann, 2021). Caffeine has an adverse effect on the mucous membrane of the digestive tract when consumed in large quantities. Chandler claims that he consumes coffee at work constantly, without controlling portions and frequency.
In addition, one should consider Chandler’s leisure time, which is associated with active alcohol consumption. In particular, he drinks 4 to 6 glasses of whiskey on average. However, it is known that alcohol is detrimental to the mucous membrane of the body and causes burns that transform into ulcers (Guest, 2021). Moreover, whiskey contains ethanol, which helps to increase the production of hydrochloric acid, irritating the inflammation area (Bokelmann, 2021). In addition, alcohol can cause the ulcer to bleed or perforate. Thus, the risks of getting ulcers and penetration of the Helicobacter pylori microbe are increased several times.
Finally, another critical factor is Chandler’s increased stress, which is not the cause, but an accelerator for forming ulcers. Stress is not the only cause of gastrointestinal diseases; it enhances other factors (Eslick, 2019). However, physical stress, in some cases, can have severe consequences on the stomach (Fichna, 2018). People who undergo complex surgery or are seriously injured risk developing a shock ulcer (Eslick, 2019). It is characterized by a release of substances that cause a decrease in blood supply to the gastrointestinal tract, vasoconstriction, and damage to the stomach wall endothelium due to a lack of oxygen and nutrients. Surgeons are aware of these risks and are working to prevent shock ulcers.
Surgery or Other Treatments
The patient underwent nasogastric intubation, which positively affected the state of health and the severity of the disease of the digestive tract. Firstly, most drugs and necessary elements were administered intravenously, skipping the stage of interaction with the stomach (Fichna, 2018). This contributed to the reduction and then the complete absence of irritation and, consequently, the cessation of bleeding (Cardoso et al., 2018). After relieving some of the symptoms and partially healing the ulcers, Chandler ate a soft diet. This regimen facilitated the scarring of ulcers and contributed to the patient’s recovery. However, the disease is in remission but has not disappeared (Cardoso et al., 2018). This tendency means the patient’s lifestyle before surgery is no longer appropriate.
Nutritional-Metabolic Data
It is known that Chandler did not have any urges, so it will not be possible to establish this type of data accordingly. However, the patient noted a darkening of the color of the feces for several days before the onset of the acute phase of the disease (Shiotani, 2018). Thus, it was possible to establish that one of the causes of the onset of the disease is the weakening of the mucous membrane and the penetration of bacteria into the epithelium (Roesler, 2019). Regarding nutritional-metabolic characteristics, Chandler has a dark-colored stool and experienced nausea without vomiting. When bleeding from a stomach ulcer, a change in the color of feces is possible – when oxidized in the stomach, the blood acquires a dark color (Shiotani, 2018). A sign of bleeding is semi-formed, with fetid black feces. Moreover, the patient’s activity and exercise characteristics include limited exercise and weakness; perception-wise, he has abdominal pain and experiences stress and restlessness.
Physical Assessment
The physical examination of the patient included abdominal auscultation, percussion, and palpation. The auscultation showed hypoactive bowel sounds, which are indicative of decreased bowel activity. During the percussion and palpation of the abdomen, the patient was visibly uncomfortable, indicating tenderness of the epigastrium. The stool-antigen test and urea breath test revealed the presence of Helicobacter pylori bacteria, while esophagogastroduodenoscopy showed multiple bleeding ulcers in the stomach lining.
Objective Data
Overall, the noted clinical manifestations include the dark coloration of the stool, it being semi-formed, and the experience of nausea without vomiting. The patient’s food intake is uneven and irregular, with high caffeine, alcohol, and unhealthy foods. Peptic ulcer of the stomach and duodenum is a chronic relapsing disease characterized by forming ulcers in the stomach and duodenum, often prone to recurrence (Chai, 2018). The gastric mucosa is constantly exposed to acid, but it usually is not damaged due to a complex system of protection against the aggressive action of the acid-peptic factor (Tachedjian et al., 2020). The patient describes the pain as sharp, burning, or stabbing, pointing to the area of the intestine’s beginning or the stomach’s location. For pain relief, the patient was taking ibuprofen; at the hospital, he was given acid-decreasing medications and antibiotics for relief.
Pharmacological Solutions
Proton pump inhibitors are antisecretory drugs intended to treat acid-dependent diseases of the stomach, duodenum, and esophagus, blocking the proton pump of the parietal cells of the gastric mucosa and reducing hydrochloric acid secretion. After passing through the stomach, Proton pump inhibitors enter the small intestine, where they dissolve (Edlavitch, 2018). At an acidic pH, proton pump inhibitors are activated and converted to tetracyclic sulfenamide, which is charged and unable to leave the acidic compartment within the secretory tubules of parietal cells (Tachedjian et al., 2020). Half of the human H+/K+-ATPases are renewed in 30-48 hours, and this process determines the duration of the therapeutic effect of PPIs (Edlavitch, 2018, p. 65). At the first or single dose of PPI, its effect is not maximal since not all proton pumps are built into the secretory membrane by this time; some are in the cytosol (Edlavitch, 2018). When these molecules and newly synthesized H+/K+-ATPases appear on the membrane, they interact with subsequent doses of PPI, and its antisecretory effect is fully realized.
H2-blockers of histamine receptors are drugs intended for the treatment of acid-dependent diseases of the gastrointestinal tract. The mechanism of action of H2-blockers is based on blocking H2-receptors of parietal cells of the gastric mucosa and reducing the production and entry of hydrochloric acid into the gastric lumen (Edlavitch, 2018). They belong to antiulcer and antisecretory drugs. H2-blockers in all pharmacological parameters are inferior to a more modern class of drugs – proton pump inhibitors, and for economic reasons, some of them are used in clinical practice (Edlavitch, 2018). Of the antisecretory agents that reduce the production of hydrochloric acid in the stomach, two classes are currently used in clinical practice: H2-blockers of histamine receptors and proton pump inhibitors. H2 blockers have a tachyphylaxis effect, while proton pump inhibitors do not (Edlavitch, 2018). Therefore, proton pump inhibitors may be recommended for long-term therapy, but H2 blockers should not be considered.
Antacids are drugs whose mechanism of action is based on the chemical neutralization of gastric acid. The main drugs used to treat acid-dependent diseases should be drugs that most effectively inhibit gastric acid production, which today are proton pump inhibitors (Edlavitch, 2018). Taking any antacids and adsorbents during the eradication of Helicobacter pylori is undesirable due to the possible decrease in the effectiveness of antibacterial treatment (Edlavitch, 2018). Antacids, having lost the lead in suppressing gastric acidity to proton pump inhibitors and other antisecretory drugs, occupy a significant niche in treating acid-dependent conditions.
In a broad sense, Prostaglandins are hormone-like substances synthesized in almost all body tissues. Without E-series prostaglandins, it is impossible to produce gastroduodenal mucus adequate in quantity and quality, secrete bicarbonates into the lumen of the stomach, and maintain sufficient volumetric blood flow in the muco-submucosal layer (Edlavitch, 2018). The lack of prostaglandins E1 and E2 decisively reduces the protective properties of the gastroduodenal mucosa.
Nursing Management
During his hospitalization, Chandler needed careful care and monitoring of his condition by specialists. While admitted, the patient was exposed to such nursing management measures as pharmacological treatment, alcohol intake cessation guided shifting to healthy dieting, and stress management consulting. To prevent pain shock or insomnia in the patient and severe spasms, it was necessary to permanently monitor the indicators and the intake of drugs by the body. In addition, the patient underwent nasogastric intubation and was organized to receive nutrients and to heal substances intravenously to avoid irritation and rejection (Brandt et al., 2020). After the disappearance of the acute pain, a mild diet was organized, and after seven days, Chandler was discharged home (Brandt et al., 2020). However, it should be noted that the patient needs care after the completion of treatment.
The patient is encouraged to consume food daily and regularly with the abstinence of smoked, fried, spicy, and hot foods, vinegar, and alcohol. All of the above products have sufficient peptic ulcer irritants for recurrence. In addition, the patient should be directed to a psychologist to develop stress-management skills (Brandt et al., 2020). Chandler should be advised on eliminating the uncontrolled use of drugs and following a plan for regular medical examinations. Moreover, the patient education topics after discharge should include nutrition of food, the importance of a healthy diet, adverse impact of substance use, stress-coping skills, and physical activity instructions.
Conclusion
In summary, it should be noted that gastric ulcer is a complex and dangerous condition that can lead to acute pain, hospitalization, and a specialized mild diet. In Chandler’s case, it was revealed which causes are the most relevant and dangerous for the manifestation of the disease, and it was established how it is possible to level them. Nevertheless, one should take care of the body and lifestyle to avoid dangerous diseases that significantly reduce the quality of life.
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