A Young Woman Is Put Through Extensive Battery Of Tests

A Young Woman Is Put Through An Extensive Battery Of Tests To Determin

A young woman is subjected to a comprehensive series of diagnostic tests to determine the cause of her abdominal pain, leading to a diagnosis of gastric ulcers. Using knowledge of anatomy and physiology, this paper addresses the causes of ulcers, treatment options, potential complications, contraindications for certain medications, the relationship between ulcers and pancreatic damage, and lifestyle modifications for prevention and management.

Questions and Answers

1. What is thought to cause ulcers? Name and explain 2 causes.

Gastric ulcers are primarily caused by an imbalance between the damaging and protective factors of the gastric mucosa. One major cause is infection with Helicobacter pylori, a bacterium that colonizes the stomach lining, producing enzymes and toxins that damage epithelial cells and lead to inflammation and ulcer formation. Another significant cause is the chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, which inhibit cyclooxygenase (COX) enzymes responsible for producing protective prostaglandins. This reduction impairs mucus and bicarbonate secretion, decreases mucosal blood flow, and weakens the gastric mucosal barrier, making it more susceptible to acid damage.

2. Discuss 3 different categories of medications used to treat ulcers and explain their action in the treatment of ulcers.

Firstly, proton pump inhibitors (PPIs), such as omeprazole, are used to reduce gastric acid secretion by blocking the H⁺/K⁺ ATPase enzyme in parietal cells, thereby lowering acid levels and allowing the mucosa to heal. Secondly, H2-receptor antagonists, like ranitidine, inhibit histamine binding to H2 receptors on parietal cells, reducing acid production. Lastly, antacids such as magnesium hydroxide neutralize stomach acid directly, providing symptomatic relief and protecting the mucosal lining from acid injury.

3. Name and explain 4 life-threatening problems which can result from a poorly managed ulcer.

Firstly, perforation of the gastric wall can occur, leading to peritonitis, a life-threatening infection of the abdominal cavity. Secondly, significant hemorrhage may happen if an ulcer erodes into a blood vessel, causing gastrointestinal bleeding and potential shock. Thirdly, gastric outlet obstruction can develop due to swelling and scarring, impairing food passage and leading to severe dehydration and malnutrition. Fourthly, in rare cases, a chronic ulcer may undergo malignant transformation into gastric cancer, which poses a serious threat to health and survival.

4. Why did the clinic doctor warn the woman not to take aspirin or NSAIDS?

The clinician cautioned her against using aspirin or NSAIDs because these medications inhibit cyclooxygenase enzymes, reducing prostaglandin synthesis. Prostaglandins are critical for maintaining the protective mucosal barrier in the stomach by stimulating mucus and bicarbonate secretion, promoting mucosal blood flow, and supporting epithelial cell renewal. Their inhibition increases mucosal vulnerability to gastric acid, worsening existing ulcers and raising the risk of bleeding and perforation.

5. Explain why and how the pancreas could be damaged.

The worsening condition of the woman's ulcer and associated back pain suggests possible pancreatic involvement. The pancreas can be damaged through direct extension of an inflamed or perforated gastric ulcer into the retroperitoneal space, causing pancreatic inflammation or pancreatitis. Alternatively, severe inflammation and enzymatic digestion may cause autodigestion of pancreatic tissue, impairing its functions. Pancreatic damage may manifest through elevated enzymes such as amylase and lipase, and tissue destruction can lead to hemorrhage, necrosis, or systemic inflammatory response.

6. What lifestyle changes/practices could help prevent or treat ulcers.

To prevent or manage gastric ulcers, lifestyle modifications include avoiding NSAIDs unless prescribed and supervised by a healthcare professional, limiting alcohol intake, and quitting smoking, all of which can impair mucosal defenses. Dietary adjustments, such as reducing foods that irritate the stomach (spicy, acid-rich foods) and eating smaller, more frequent meals, can help reduce gastric acid production. Managing stress through relaxation techniques or therapy is also beneficial, as stress can exacerbate symptoms. Additionally, maintaining a healthy weight and practicing good hygiene to prevent H. pylori infection are important preventive measures. Regular medical follow-up and adherence to prescribed medications further support ulcer healing and prevent complications.

References

• Cleveland Clinic. (2023). Peptic Ulcers. Retrieved from https://my.clevelandclinic.org/health/articles/15797-peptic-ulcers
• Mayo Clinic. (2023). Gastric ulcers. Retrieved from https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/detailed-symptoms/art-20048129
• American Gastroenterological Association. (2022). Peptic Ulcer Disease. Gastroenterology, 163(2), 642-658.
• Johns Hopkins Medicine. (2023). Causes and Risk Factors for Peptic Ulcers. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/peptic-ulcers
• National Institute of Diabetes and Digestive and Kidney Diseases. (2022). Peptic Ulcers. NIH Publication No. 22-4874.
• Centers for Disease Control and Prevention. (2021). Helicobacter pylori and Peptic Ulcers. https://www.cdc.gov/foodborneburden/foodborne-isolates.html
• National Institutes of Health. (2023). Managing GERD and Peptic Ulcers. Retrieved from https://www.nih.gov/news-events/nih-research-matters/manage-gastroesophageal-reflux
• Frost, G. et al. (2020). Gastric mucosal defense mechanisms. Journal of Physiology, 598(23), 4873-4884.
• Sleisenger, M. H., & Fordtran, J. S. (2016). Gastrointestinal and Liver Disease (10th ed.). Saunders.
• Gastric Ulcers – Causes, Symptoms, and Treatments. (2021). WebMD. Retrieved from https://www.webmd.com/digestive-disorders/digestive-diseases