CASE STUDY

Submitted By Ayatullah Siddiqui ID: 0910269046 Course: Pharmacology 3 (PHR324.1) Submitted To Dr. Rajib Bhattacharjee Assistant Professor Dept. of Pharmacy, NSU

CASE STUDY -1
A 37-year-old executive returns from office for recurrent upper abdominal pain. He initially complaining of an increase in frequency and severity of burning epigastric pain, which he has experienced occasionally for more than 2 years. Now the pain occurs three or four times per week, usually when he has an empty stomach, and it often awakens him at night. The pain usually is relieved within minutes by food or over-the-counter antacids but then recurs within 2 to 3 hours. He admitted that stress at work had recently increased and that because of long working hours, he was drinking more caffeine and eating a lot of take-out foods. His medical history and review of systems were otherwise unremarkable, and, other than the antacids, he takes no medications. His physical examination was normal, including stool that was negative for occult blood. No anemia, but his serum Helicobacter pylori antibody test was positive. Summary: A 37-year-old man presents with complaints of chronic and recurrentupper abdominal pain with characteristics suggestive of duodenal ulcer: the pain is burning, occurs when the stomach is empty, and is relieved within minutesby food or antacids. He does not have evidence of gastrointestinal bleeding or anemia. He does not take nonsteroidal antiinflammatory drugs, which might cause ulcer formation, but he does have serologic evidence of H pylori infection. Most likely diagnosis: Peptic ulcer disease Next step: Antibiotic therapy for H pylori infection Treatment:Common treatment regimens for Helicobacter pylori infection include a 14-day course of a proton-pump inhibitor in high doses (e.g., lansoprazole 30 mg twice daily or omeprazole 20 mg twice daily, Amoxicillin BP 500mg capsule bid, Clarithromycin USP 500mg once a day.

CASE STUDY-2

A 28-year-old man comes to the emergency room complaining of 2 days of

abdominal pain and diarrhea. He describes his stools as frequent, with 10 to 12 per day, small volume, sometimes with visible blood and mucus, and preceded by a sudden urge to defecate. The abdominal pain is crampy, diffuse, and moderately severe, and it is not relieved with defecation. In the past 6 to 8 months, he has experienced similar episodes of abdominal pain and loose mucoid stools, but the episodes were milder and resolved within 24 to 48 hours. He has no other medical history and takes no medications. He has neither traveled out of the United States nor had contact with anyone with similar symptoms. He works as an accountant and does not smoke or drink alcohol. No member of his family has gastrointestinal (GI) problems. On examination, his temperature is 99F, heart rate 98 bpm, and blood pressure 118/74 mm Hg. He appears uncomfortable, is diaphoretic, and is lying still on the stretcher. His sclerae are anicteric, and his oral mucosa is pink and clear without ulceration. His chest is clear, and his heart rhythm is regular, without murmurs. His abdomen is soft and mildly distended, with hypoactive bowel sounds and minimal diffuse tenderness but no guarding or rebound tenderness. Laboratory studies are significant for a white blood cell (WBC) count of 15,800/mm3 with 82% polymorphonuclear leukocytes, hemoglobin 10.3 g/dL, and platelet count 754,000/mm3. The HIV (human immunodeficiency virus) assay is negative. Renal function and liver function tests are normal. A plain film radiograph of the abdomen shows a mildly dilated air-filled colon with a 4.5-cm diameter and no pneumoperitoneum or air/fluid levels.

Summary: A 28-year-old man comes in with a moderate to severe

presentation of colitis, as manifested by crampy abdominal pain with tenesmus, lowvolume bloody mucoid stool, and colonic dilatation on X-ray. He has no travel or exposure history to suggest infection. He reports a history of previous similar episodes, which suggests a chronic inflammatory rather than acute infectious process. Most likely diagnosis: Colitis, probably ulcerative colitis. Next step: Admit to the hospital, obtain stool samples to exclude infection. Treatment is with anti-inflammatory drugs, immunosuppression,

and biological therapy targeting specific components of the immune response. Colectomy (partial or total removal of the large bowel through surgery) is occasionally necessary, and is considered to be a cure for the disease.