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 smoker NSAIDs H.pylori 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 abdominal pain present for the last two days burning sensation partially relieved by eating and antacids vomiting occurs with the pain moderately severe felt lethargic and weak stool is soft and black for the last 2 days low back pain with x-ray of lumbar spine showing moderate degenerative changes

2.1.2. Previous medical / surgical history long history of dyspepsia with epigastric pain 3 episodes of pain in the last year each lasting 2-3 weeks moderate HTN controlled with felodipine cholecystectomy 10 years ago moderate chronic airflow limitation related to lifelong smoke osteoarthritis affecting the hips did chest x-ray 3 years ago showed no abnormality barium meal showed scarred stomach many years ago

2.1.3. Drug history / allergy over the counter ramintidine tablets for a week to relieve the pain felodepine pyroxicam prescribed for her husband daily for the last three weeks

2.1.4. Family history father had stomach ulcer -died of IHD at 72

2.1.5. Social / occupational history smoker stopped smoking for 5 years widowed 2 years ago living alone with some support 2 children that are married and living in jeddah largely independent

2.1.6. Systemic review

2.1.7. Physical examination Vital sings afebrile P 80 regular with no postural tachycardia BP 160/90 supine 135/80 sitting RR 14 general calm and alert GIT abdomen is soft and not distended, mild epigastric tenderness rectal examination- melinna CVS grade 2/6 systolic murmer heard over aortic area RESP slightly hyper resonant on percussion

2.1.8. tests results CBC low Hb 9 Chest xray `normal endoscopy two cm gastric ulcer in pre-pyloric region on greater curvature old clot and visible nonbleeding vessels altered blood in stomach scattered erosion affecting the antrum and body of stomach vessel treated heater probe histo chronic active gastritis with numerous H.pylori organisms coagulation screen normal biochemistry 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 defintion pathophysiology etiology causes drugs that cause ulcer cancer GERD presentation diagnosis

3.2. Report new knowledge

3.3. 30 minutes

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