NUT302 - Peptic Ulcer Case Study PDF

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Peptic ulcer case study with answers...

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Peptic Ulcers Case Study 1 Mr Crouse (60yrs) is hospitalised with acute pain on his stomach and hematemesis. He is referred to the dietitian for counselling after diagnosis of a peptic ulcer.   

MHx: Hypertension, Dyslipidemia Bloods: Positive rapid urease test for H. pylori, lipids within normal range Weight: 82kg, was 88 kg 1 month ago, 1.78m

In your nutrition assessment of him you find he complains of a burning sensation on his stomach when he eats, he sometimes feel nauseas and don’t have much of an appetite and more recently he has been vomiting blood. He believes orange juice and tomatoes (all tangy foods) will burn his stomach so he is avoiding that. He drinks a glass of milk each time his stomach starts to burn to blunt the burning sensation. Medication: Gaviscon, Aspirin – self prescribed; Capoten, Lipitor, Omeprazole, Tetracycline He’s been using Aspirin daily for a number of years as he knows it helps to reduce one’s risk of heart-related problems. Questions 1. What type of peptic ulcer do you suspect he has? Explain your answer. - Gastric ulcer. Due to burning sensation while eating, as opposed to duodenal ulcers which have burning several hours after eating. Bloods reveal H pylori positive. Hematemesis occurs only in gastric ulcers as it remains in stomach. 2. What advice will you give Mr Crouse regarding his avoidance of orange juice and tomatoes? - Stomach acid pH is not impacted by food pH. Advise him that he only needs to avoid foods if they cause discomfort or increase acid secretion: commonly pepper, caffeine and alcohol. 3. What is your opinion about Mr Crouse’s strategy to have milk when his stomach burns? - Milk and cream increase gastric acid and pepsin secretion, which can increase pain. While he may think that having milk will soothe his stomach and lessen his symptoms, educate him that these products actually increase gastric acid 4. What advice will you give Mr Crouse regarding the food he eats when he has a flare-up? - Avoid high-fat foods eg. Fried, processed meats, full-cream dairy. This delays gastric emptying, therefore more acid in stomach for longer time period (more pain) - Avoid pepper, alcohol, caffeine e.g. cola, coffee, tea, cocoa as they increase acid secretion

Peptic Ulcers Case Study 2 Mrs Stark (34 yr) recently underwent a vagotomy (vagus nerve cut to reduce the rate of gastric secretions) and gastroduodenostomy (Billroth I) to remove a peptic ulcer. She has now come to see you two-weeks after discharge in the Outpatient clinic. Anastomosed proximal stomach to duodenum.    

MHx: Peptic ulcer, Depression Bloods: Sodium: 130 mmol/L, K: 3.1 mmol/L (Low), Hb: 111 g/L (Low), MCV: 79 fL (Low), ferritin: 28 ug/L = microcytic anaemia/iron deficiency anaemia and hypokalaemia Weight Hx: 2-weeks ago: 57kg, prior to hospitalisation: 60kg, current weight: 55kg. Height = 1.71m Medication: Tetracycline (antibiotics; diarrhoea), Fentanyl (pain).

She complains of suffering from diarrhoea some days and that usually is preceded by a feeling of being blown up which is quite painful. This often leaves her feeling quite weak and even shaky. Her diet history is: B: Fruit salad with white tea and sugar MT: blueberry muffin with white tea and sugar L: Sandwich with fresh honey and cheese, a fruit e.g. kiwi and water AT: nuts and yogurt D: Rice, chicken or beef, veggies and salad with milk or kombucha Questions 1. What most likely caused her nutrition impact symptoms? How will you explain this to her? (Diarrhea and abdominal pain) Dumping syndrome occurs as important digestion steps are missed following the removal of the pyloric sphincter. In a healthy person food usually remains in the stomach for 1-3 hours to liquefy and partially digest. Usually food will then enter the small intestine slowly through the pyloric sphincter in order for the acidic chyme to be neutralised by pancreatic bicarbonate. As this patient has no pyloric sphincter due to the surgery, dumping syndrome occurs. Chyme from the stomach is hyperosmolar; therefore fluid is drawn into the small intestine from the vascular compartment in an attempt to dilute the contents. From this cramping, abdominal pain, diarrhea and hyper motility result. Weakness and tachycardia resulting from a decreased blood volume following the fluid being drawn into small intestine. Dizziness and shakiness follows caused by rebound hypoglycaemia as a result of increased insulin release after rapid absorption of carbohydrates. 2. What strategies and dietary changes can you recommend to manage her NIS symptoms? - Well-balanced diet - Avoid simple sugars in order to prevent hyperosmolarity and hypoglycaemia associated with dumping syndrome (rapid absorption of simple sugars in the small intestine stimulates insulin release. Quick movement and absorption of food through the small intestine, blood glucose levels drop rapidly as insulin promotes glucose uptake into cells). - Lactose if often not tolerated – provide lactase or lactose free products. - Liquids to be consumed between meals to prevent their contribution to dumping syndrome (when consumed with meal dumping syndrome more likely to occur) - eating smaller meals through the day (5-6 small meals) - The main priority will be to slow down the food travelling through the GI tract - Lay down after meals to aid in slowing movement of meal through stomach to intestines. - Antidiarrhea medications - liquid intake until 30 minutes to one hour after a meal, increasing intake of fibre, protein and complex CHO, and increasing the thickness of food. 3. Identify all potential nutrition problems that Mrs Stark presents with considering her nutrition assessment information. - Iron deficiency (antacids) - Hypokalaemia and hyponatremia (dumping syndrome) - Dehydration - Malnutrition (9% weight loss since hospitalisation).

4. Write two to three potential nutrition diagnoses for her. Inappropriate intake of carbohydrates (simple vs. complex) related to food and nutrition knowledge deficit regarding dumping syndrome as evidenced by frequent intake of simple carbohydrates such as sugar and honey and signs and symptoms of dumping syndrome. Food and nutrition related knowledge deficit related to food and drink intake inconsistent with that recommended for dumping syndrome (avoidance of simple sugars and food and drink at the same time) as evidenced by diet history and presence of nutrition impact symptoms....