Question

Harvey, a 26 year old graduate student, was brought to the emergency room by a friend. He showed extreme anxiety and complained of sudden excruciating upper abdominal pain a few hours after a meal of spicy pizza and wine followed by a cup of coffee. Harvey had been experiencing mild abdominal pain irregularly for several years but found that drinking milk or taking antacid tablets usually relieved his distress within a few minutes. He liked to cook and eat well and was slightly overweight. Though Harvey had taken his normal dose of two antacid tablets the pain did not subside. He did mention that he was on academic probation and believed he had to recover quickly so as to prepare for his next major test at school. Harvey stated that to help relieve stress he smokes about 1 pack of cigarettes a day.

Assesments revealed that Harvey’s stomach and small intestines were active. His blood pressure was slightly elevated and urea was detected on his breath. An Upper endoscopy (EGD) procedure revealed a perforated ulcer and he was scheduled for surgery.

Please respond to each of the following in your reply:

1. Where do you think Harvey's ulcer was located? What factors lead you to this answer?
2. What factor or factors probably led to Harvey's ulcer?
3. What tests might they have used to evaluate his condition?  
4. In addition to surgery, the doctor prescribed an antibiotic and the continuation of antacids for Harvey. Why would these be prescribed?

Answer 1

1. In Harvey's condition the perforated ulcer can be located in the duodenum. Because duodenal ulcers are increased after meal and can be relieved by food or antacids.
2. The major factors that contribute this ulcer was smoking, stress and caffeine use of Harvey.
3. Urea breath test , IgG antibody detection test for H.pylori , Biopsy , culture and Esophagogastroduodenoscopy.
4. In perforated ulcers antibiotics are used to treat H.pylori infection.and antacids are used to decrease acid secretion to reduce mucosa erosion and aid in healing ulcer.