Peptic ulcer case

• Chief Complaint“My stomach has been hurting for the past few weeks. Over theweekend, I noticed my bowel movements were black and tarry.” HPIWilliam Smith is a 62-year-old man who presents to the emergencydepartment on Sunday evening complaining of intermittent burningepigastric pain for more than 2 months. His pain is non-radiating andoccurs to the right of his epigastrium. This pain changes in intensityand is worse with meals. He also has noticed intermittent belching,being bloated, being weak when walking, and complains of nauseaafter eating. Since last Friday, he has been having black, tarry bowelmovements. He does not have any history of PUD or GI bleeding andhas not experienced anorexia or vomiting.

PMH• COPD × 10 years• Type 2 DM × 10 years• Osteoarthritis × 15 years in the right shoulder

• FH• His father died at age 55 of an acute MI and his

mother died at agen66 from lung CA. He has three siblings who are alive and well.

• SH• Presently employed as an accountant. He is

married and has three daughters. He still smokes a cigar occasionally despite his COPD, and he drinks a case of beer per week.

MedsMetformin 500 mg po twice dailyEC aspirin 325 mg po once dailyIpratropium MDI 2 puffs 4 times dailyAlbuterol MDI 2 puffs PRNIbuprofen 200 mg 2 tablets PRN shoulder painMaalox 1 tablespoonful PRN stomach pain

AllPenicillin

ROSUnremarkable except for complaints noted above

• VS• BP 120/62 right arm (seated), P 109, RR 18

reg, T 37.9°C; Wt 102 kg, Ht 5'9‘’

Labs

• BUN 10 mg/dL • MCV 74 μm• SCr 1.1 mg/dL• FBG 154 mg/dL • Fe 49 mcg/dL• Hgb 9.2 g/dL • Ca 9.2 mg/dL• Albumin 3.9 g/dL