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)

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.

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)

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