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P
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riane
rd
me, Aroseph Berna
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l
o
t
r
a
B
omo, J
e
Crisostez, Jacquelin
u
e
Marq to, Kathrin
Rober se, Regine
S an Jo
3C

ULCERS
Due to defects in control of secretion and
motility or in synthesis of PG
That results to excessive production of gastric acid and
pepsin or from decreased mucosal resistance to these
substances

Local erosions of the mucosa

Predisposing factors
Faulty dietary habits
Excessive smoking, aspirin and drinking of
coffee and cola drinks
Rushing through meals, improper selection of
food and irregular mealtime
Heredity, physical stress, emotional conflicts,
psychic trauma

2 TYPES
Peptic Ulcer
Gastric Ulcer

Peptic Ulcer
Eroded lesion in
duodenal mucosa

the

gastric

mucosa

or

Principle cause: acidic environment

Most duodenal ulcers occur within 3 cm of
pylorus (point where gastric acidity is high)

PATHOGENESIS
Increased capacity to secrete acid in response to gastrin due to
increased number of parietal cells
Increased sensitivity of parietal cells to gastrin
Hypersecretion of gastrin in response to meals
Decreased ability to inhibit gastrin released when the acidity of gastric
content drops too low
Increased nocturnal gastric secretion
Rapid entry of acidified chime into the duodenum that cannot be
neutralized rapidly enough

Gastric Ulcer
Usually found in the antrum of stomach

Pathogenesis
Gastritis or inflammation of antrum or pyloric gland
areas tends to occur with gastric ulcer and may be
a pre-ulcer condition
Chronic backward diffusion of hydrogen ions after
the normal gastric mucosal barrier is disrupted
which then results in gross mucosal damage
A disturbance in antroduodenal motility can cause
bile acids from the duodenum to reflux back into
the stomach and break the mucosal barrier and
cause gastritis

TREATMENT
Objectives for treatment:
Relief of pain
Healing of ulcer
Reduction of tendency to recur

MEDICAL MANAGEMENT
Antacids neutralize excess acidity
Aluminum hydroxide
Magnesium hydroxide

Antispasmodics inhibit motility and relieve pain

Anticholinergics inhibit acid secretion
H2 receptor antagonist (Cimetidine)
Proton pump inhibitor (Omeprazole)

DIETARY MANAGEMENT
Adequate calorie to maintain DBW
High protein intake
Adequate carbohydrates to provide energy and
spare protein
High fats (unsaturated fatty acids)
Small frequent meals

DIETARY MANAGEMENT
Restrict fiber intake
Avoid gastric secretagogues (caffeine, cola
drinks and alcohol)
Avoid food that are gas-formers (milk, onion,
spicy food, etc.)
Avoid NSAIDs and steroids

CASE: HISTORY
Ms. W., 23 years old, has been admitted to hospital
with an acute, upper gastrointestinal bleed. She had
been using naproxen 500 mg twice daily, chronically
over the past two years, with adequate control of her
symptoms of Rheumatoid Arthritis. She was not using
any other medications on presentation, and has not
developed any other medical. She has already been in
the hospital for three days, and the bleeding has
ceased. A gastroscopy performed on admission
revealed the presence of a duodenal ulcer with a nonbleeding visible vessel. It was treated endoscopically

CASE:
MEDICATIONS:
Naproxen 500mg twice daily
PHYSICAL EXAMINATION
Height: 163cm

Weight: 60 kg

Blood pressure: 110/80

Mild epigastric tenderness
Guaiac-positive stool resulting from occult blood loss

DIAGNOSIS
NSAID-induced
DUODENAL ULCER

MANAGEMENT
Discontinue Naproxen
Begin administration of Proton-pump Inhibitors
(for ulcer) with COX-2 Inhibitors (for arthritis)

COMPUTATIONS
BMR = 655.1 + (9.6 x wt kg) + (1.8 x ht cm) (4.7 x age)
= 655.1 + (9.6 x 60) + (1.8 x 163) (4.7 x 23)
= 1416 kcal
TER = BMR x AF x IF
= 1416 x 1.3 (very light) x 1.35 (mod. Stress from chronic illness)
= 2485.08 or 2485

CHO = 2485 x 0.55 = 1366.75 / 4 = 341.69 or 340

CHON = 2485 x 0.15 = 372.75 / 4 = 93.19 or 95
FATS = 2485 x 0.30 = 745.5 / 9 = 82.83 or 80

FOOD EXCHANGE LIST

FOOD

# of
EXCHANGE

CHO

CHON

FATS

ENERGY

Vegetable A

16

Vegetable B

16

Fruit

40

Milk

24

Sugar

20

Rice

10

230

Meat

Fat

160
16

20

340
80

20
48

1000
42

570

25

225

DIVIDING DAYS EXCHANGES

BETWEEN MEALS
FOOD

EXCHANG BREAKFAS AM SNACK

E
T

Vegetable
A

Vegetable
B

Fruit

Milk

Sugar

LUNCH

PM SNACK

DINNER

2
1
1

1
1

Rice

10

Meat

2
2

TRANSLATING A DAYS EXCHANGES

INTO A DAYS MEAL
BREAKFAST

1 cup rice

AM SNACK

LUNCH

Melon Juice
1 cup rice
- 1 slice
3 tbsps Corned
melon
Chicken tinola
- 2 tsps sugar - Upo
beef + Olive
- 2 medium
oil
Tuna Sandwich
sized wings
- Olive oil
4 level tsps in - 2pcs

PM SNACK

DINNER

Peanut butter
& jelly
- 4tsps jelly
- 4 tsps
peanut

Sinigang na
Isda
- Malunggay
- 2 slices
carpa

4 pcs Pan

1 cup rice


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