PBL 1 session 3

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PBL 1 session 3 by Mind Map: PBL 1 session 3

1. Step 8

1.1. Diagnostic decision

1.1.1. Peptic ulcer disease - in stomach

1.2. Mechanism

1.2.1. chronic gastritis

1.2.1.1. smoker

1.2.1.2. NSAIDs

1.2.1.3. H.pylori

1.2.1.4. family history

1.3. Presentation

1.3.1. burning recurrent epigastric pain

1.3.2. N&V

1.3.3. soft black stool

1.4. Supporting data

1.4.1. endoscopy

1.4.2. +ve history

1.5. 10 minutes

2. Step 7

2.1. Inquiry plan and info gathering

2.1.1. History of presenting complaint

2.1.1.1. abdominal pain

2.1.1.1.1. present for the last two days

2.1.1.1.2. burning sensation

2.1.1.1.3. partially relieved by eating and antacids

2.1.1.1.4. vomiting occurs with the pain

2.1.1.1.5. moderately severe

2.1.1.2. felt lethargic and weak

2.1.1.3. stool is soft and black for the last 2 days

2.1.1.4. low back pain with x-ray of lumbar spine showing moderate degenerative changes

2.1.2. Previous medical / surgical history

2.1.2.1. long history of dyspepsia with epigastric pain

2.1.2.2. 3 episodes of pain in the last year each lasting 2-3 weeks

2.1.2.3. moderate HTN controlled with felodipine

2.1.2.4. cholecystectomy 10 years ago

2.1.2.5. moderate chronic airflow limitation related to lifelong smoke

2.1.2.6. osteoarthritis affecting the hips

2.1.2.7. did chest x-ray 3 years ago showed no abnormality

2.1.2.8. barium meal showed scarred stomach many years ago

2.1.3. Drug history / allergy

2.1.3.1. over the counter ramintidine tablets for a week to relieve the pain

2.1.3.2. felodepine

2.1.3.3. pyroxicam prescribed for her husband

2.1.3.3.1. daily for the last three weeks

2.1.4. Family history

2.1.4.1. father had stomach ulcer -died of IHD at 72

2.1.5. Social / occupational history

2.1.5.1. smoker

2.1.5.1.1. stopped smoking for 5 years

2.1.5.2. widowed 2 years ago living alone with some support

2.1.5.3. 2 children that are married and living in jeddah

2.1.5.4. largely independent

2.1.6. Systemic review

2.1.7. Physical examination

2.1.7.1. Vital sings

2.1.7.1.1. afebrile

2.1.7.1.2. P 80 regular with no postural tachycardia

2.1.7.1.3. BP 160/90 supine 135/80 sitting

2.1.7.1.4. RR 14

2.1.7.2. general

2.1.7.2.1. calm and alert

2.1.7.3. GIT

2.1.7.3.1. abdomen is soft and not distended, mild epigastric tenderness

2.1.7.3.2. rectal examination- melinna

2.1.7.4. CVS

2.1.7.4.1. grade 2/6 systolic murmer heard over aortic area

2.1.7.5. RESP

2.1.7.5.1. slightly hyper resonant on percussion

2.1.8. tests results

2.1.8.1. CBC

2.1.8.1.1. low Hb 9

2.1.8.2. Chest xray

2.1.8.2.1. `normal

2.1.8.3. endoscopy

2.1.8.3.1. two cm gastric ulcer in pre-pyloric region on greater curvature

2.1.8.3.2. old clot and visible nonbleeding vessels

2.1.8.3.3. altered blood in stomach

2.1.8.3.4. scattered erosion affecting the antrum and body of stomach

2.1.8.3.5. vessel treated heater probe

2.1.8.4. histo

2.1.8.4.1. chronic active gastritis with numerous H.pylori organisms

2.1.8.5. coagulation screen

2.1.8.5.1. normal

2.1.8.6. biochemistry

2.1.8.6.1. urea 8-11 elevated

2.2. 50 minutes

3. Step 6

3.1. Review session 1

3.1.1. to discuss relevant anatomy and physiology of upper GIT

3.1.2. to understand Peptic ulcer disease stressing on

3.1.2.1. defintion

3.1.2.2. pathophysiology

3.1.2.3. etiology

3.1.2.4. causes

3.1.2.4.1. drugs that cause ulcer

3.1.2.4.2. cancer

3.1.2.4.3. GERD

3.1.2.5. presentation

3.1.2.6. diagnosis

3.2. Report new knowledge

3.3. 30 minutes

3.3.1. The scribe does not have to write in this step!