Management of a patient with Peptic Ucler Disease

It is anticipated that the initial discussion post should be in the range of 250-300 words.
Response posts to peers have no minimum word requirement but must demonstrate topic
knowledge and scholarly engagement with peers. Substantive content is imperative for all
posts. All discussion prompt elements for the topic must be addressed. Please proofread
your response carefully for grammar and spelling. Do not upload any attachments unless
specified in the instructions. All posts should be supported by a minimum of one scholarly
resource, ideally within the last 5 years. Journals and websites must be cited
appropriately. Citations and references must adhere to APA format.

Management of a patient with Peptic Ucler Disease

A 60-year-old white female presents to your office for a follow-up after a recent Urgent
Care visit with her daughter.
 The patient’s daughter reports that the patient has not been eating much for
the past few weeks and complains of a gnawing pain in her stomach when she
does eat and reports that she seems to be getting “full” very quickly with eating.
 The patient complains of mild nausea over the last two weeks.
 The patient has a history of a recent fall from a ladder about 9 months ago in
which she shattered multiple teeth and develop and infection. She has been
under the care of an oral surgeon for this.
 Her daughter reports that she has been having an increase in forgetfulness and
that the patient’s colleagues have noticed she seems to be “off her game” for
the last few weeks.
 Yesterday she was evaluated at Urgent Care and found to have a hemoglobin of
8.5 and hematocrit of 25, and she was instructed to follow-up in your office
today.
 Upon examination today his lung sounds are clear and heart rhythm is regular.
She has mild tenderness on palpation over her upper abdomen, but normal
bowel sounds.  Her skin is pale and dry.  No other abnormalities are noticed on
exam.

Please develop a discussion post that responds to each of the following prompts.  Where
appropriate your discussion needs to be supported by scholarly resources.  Be sure to
include in-text citations in the context of the discussion and provide a full reference
citation at the end of the discussion post:
 Provide your diagnosis.

 Discuss how you would treat the patient’s current presentation and provide a
rationale supported by scholarly reference for your treatment plan.
 Include your specific prescription(s) for the patient. (This must include the
medication name, dose, route, and frequency as well as any special instructions
that apply as you would include when writing a prescription).
 Describe the patient education you would provide in relation to your treatment
plan.
 Provide your plan for follow-up and/or referral (if indicated)
Please be sure to validate your opinions and ideas with citations and references in APA
format.
Your initial response is due by Wednesday at 11:59 pm CT.
Estimated time to complete: 2 hours

What I got using chatgpt

Diagnosis
The patient presents with iron deficiency anemia (IDA) secondary to gastrointestinal (GI) blood
loss, likely from a peptic ulcer or possible malignancy, given her symptoms of early satiety,
gnawing epigastric pain, and mild nausea. The history of a fall with dental trauma and infection
raises the possibility of chronic inflammation or poor nutritional intake contributing to her
anemia, but the primary concern is an occult GI source. The cognitive decline may also be a
consequence of anemia and hypoxia.

Treatment Plan

1. Laboratory Workup & Diagnostic Evaluation

• CBC with differential (to assess severity of anemia and rule out other causes such as hemolysis
  or malignancy)
• Ferritin, iron, TIBC (to confirm iron deficiency)
• Reticulocyte count (to assess bone marrow response)
• B12 and folate levels (to rule out other nutritional anemias)
• CMP (to evaluate liver and kidney function)
• Fecal occult blood test (FOBT) or fecal immunochemical test (FIT) (to check for GI bleeding)
• Upper endoscopy (EGD) and possibly colonoscopy to assess for ulcer disease, gastritis, or
  malignancy

1. Treatment of Iron Deficiency Anemia
   Medication Prescription:

• Ferrous sulfate 325 mg PO three times daily with vitamin C (e.g., orange juice) to enhance
  absorption
• Proton pump inhibitor (PPI) if peptic ulcer is suspected:
• Omeprazole 40 mg PO daily before breakfast for at least 4-8 weeks
• H. pylori testing (if positive, initiate eradication therapy)
• Possible transfusion if the patient is symptomatic with significant fatigue, tachycardia, or
  syncope (Hb <7.0 g/dL)

1. Management of Cognitive Symptoms

• Addressing anemia should improve cognition, but further neurocognitive evaluation may be
  necessary if symptoms persist after correction.

Patient Education

• Iron Therapy:
• Take iron supplements with vitamin C to improve absorption.
• Avoid taking iron with calcium, dairy, or antacids, as they inhibit absorption.
• Expect dark stools and possible mild GI discomfort.
• Peptic Ulcer Disease:
• If diagnosed, adhere to PPI therapy and avoid NSAIDs, alcohol, and smoking.
• If H. pylori positive, complete the full course of antibiotics.
• Signs of Worsening Symptoms:
• Seek immediate medical care for black/tarry stools, vomiting blood, dizziness, or worsening
  fatigue.

Follow-Up & Referral Plan

• Follow-up in 2 weeks to reassess symptoms and check repeat hemoglobin and iron studies.
• GI referral for endoscopy to rule out peptic ulcer disease, gastritis, or malignancy.
• Neurology referral if cognitive symptoms persist despite anemia correction.

This approach ensures a comprehensive evaluation and treatment plan based on best practices
and evidence-based guidelines.