NURS 300: Pathophysiology of Duodenal Ulcer and Urolithiasis Report

This report provides a comprehensive analysis of the pathophysiology of duodenal ulcers and urolithiasis. It details the disease processes, including the mechanisms of injury and stone formation. The report outlines the signs and symptoms reported by patients, along with the physical assessment findings and diagnostic tests used to confirm the diagnoses. Furthermore, it offers pharmacologic recommendations, specifying drug classes, indications, mechanisms of action, side effects, contraindications, and patient education for both conditions, including the use of amoxicillin for duodenal ulcers and allopurinol for urolithiasis. The report integrates evidence from scholarly sources, citing multiple peer-reviewed articles and a textbook to support the information presented. The report fulfills the assignment brief requirements of addressing the pathophysiology, signs and symptoms, physical assessment findings, diagnostic tests, and pharmacologic recommendations with supporting scholarly citations.

Running head: PATHOPHYSIOLOGY 1
Pathophysiology
Students Name
Institutional Affiliation

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Duodenal Ulcer
Pathophysiology
Duodenal ulcer result from damage or erosion of the protective lining of the duodenal
mucosa. Epithelial cells situated in the duodenum produce mucus as a defensive mechanism due
to epithelial irritation (Pietroiust, Gomez, & Luzzi, 2017). Once there is a physiologic imbalance
between aggressive factors and defensive mechanism; mucosal damage takes place. Injury to the
duodenum enhances H. Pylori growth and inflammation. H. Pylori impairs the ability of the
duodenal bulb to counteract the acidity entering from the stomach, causing an ulcer to develop.
Signs and symptoms
The client reports heartburn, nausea, vomiting, and feeling lightheaded.
Assessment and diagnostic findings
A physical examination may reveal a mild epigastric tenderness on palpation. Clients with a
perforated duodenal ulcer manifest with a severe, sharp abdominal pain. The client may also
present with rebound tenderness, rigidity and guarding during an abdominal examination. A
barium study may reveal an ulcer. This entails drinking barium containing substance as an x-ray
is taken; the barium makes it easy for the gastrointestinal tract (GIT) to be seen more clearly.
Endoscopy can be performed to expose lesions that were not observed during x-ray (Sung, Yung,
& Chiu, 2016). Through direct endoscopy visualization of ulcers and lesions is achieved, and a
suspicious lesion can be obtained by biopsy. H. pylori may be confirmed through a breath test
that detects the bacteria or serological test for antibodies produced as a result of H. pylori
antigen.

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Pharmacologic recommendation
Currently, a combination of antibiotics has been used in the treatment of ulcers. The strongly
recommended drug is amoxicillin.
Drug class
Amoxicillin is an antiulcer and anti-infective agent. It is classified as an aminopenicillin.
Indication
It is mostly indicated in the management ulcer disease caused by H. pylori infection,
respiratory infections, endocarditis and genitourinary infections (Sung, Yung, & Chiu, 2016).
Action
Amoxicillin adheres to the bacterial cell wall, causing cell death.
Side effects
In the GIT system, it causes nausea and vomiting, diarrhoea and increased liver enzyme. High
doses of amoxicillin may cause seizures. Miscellaneous side effects include superinfections,
anaphylaxis and serum sickness.
Contraindication
Amoxicillin is contraindicated in patients hypersensitive to penicillin such as the cephalosporin
and the beta-lactam. It should be used cautiously in severe renal insufficiency, lymphocytic
leukaemia and infectious mononucleosis (Sung, Yung, & Chiu, 2016).

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Patient teaching
Educate the patient on the importance of taking the drug on time, and to finish the prescribed
dosage even if the individual is feeling better. Teach the client how to calculate and measure
doses correctly. Insist on the use of measuring devices provided by the pharmacy and not
household items (Sung, Yung, & Chiu, 2016).
Urolithiasis
Pathophysiology
Urolithiasis is the process of formation of stones or calculi in the urinary tract. The
development of stones is usually associated with an increase in calcium phosphate, calcium
oxalate and uric acid. The development of stone begins with crystal formation in the
supersaturated urine. If the crystal is large enough, it gets fixed to the urothelium creating a
central point for stone growth (Aggarwal, Narula, & Tandon, 2016). The stones may obstruct the
drainage system resulting in bleeding, infection, severe pain, and kidney infection.
Signs and symptoms
The signs and symptoms depend on obstruction oedema and infection. When there is a
urethral obstruction, the patient complains of excruciating pain radiating down the thigh. Little
urine is passed and usually contains blood. Other symptoms include fever, chills, diarrhoea,
nausea and vomiting (Kerry, Suzanne, Brenda, & Janice, 2014).

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Assessment and diagnostic findings
A client suspected with urolithiasis is assessed for pain and discomfort in addition to
associated symptoms such as abdominal distension, diarrhoea, nausea and vomiting. On
palpation of the abdomen, there is severe ipsilateral and flank pain which radiates to the vulvar
or testicles. The diagnosis is confirmed by x-ray films of the bladder, ureter and the kidney. A
plain abdominal radiograph is used to assess the location, size, composition of the stone. Other
tests include dipstick test to check for bacteriuria and serum creatinine level to check for renal
functioning (Randall, 2017).
Pharmacologic recommendation
The medical intervention of urolithiasis involves administration of drugs and supportive care.
One of the drugs used in the treatment of urolithiasis is allopurinol.
Drug class
Allopurinol is an antihyperuricemic and antigout agent. It is classified as xanthine oxidase
inhibitors (Moe, 2018).
Indications
Used in the treatment of hyperuricemia, leukaemia and prevents gouty arthritis (Moe, 2018).

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Action
It prevents the action of xanthine oxidase hence inhibiting the production of uric acid;
lowering serum uric acid levels (Moe, 2018).
Side effects
In the cardiovascular system, it causes hypotension, hypertension, and heart failure. It affects
the central nervous system causing drowsiness. The GIT is also affected, leading to hepatitis,
nausea, vomiting and diarrhoea (Moe, 2018).
Contraindication
It is contraindicated to patient hypersensitive to allopurinol. It should be used cautiously to
patients with renal insufficiency and acute attacks of gout (Moe, 2018).
Patient teaching
Instruct the client to take allopurinol as prescribed and take missed doses as soon as
remembered. Recommend alkaline diet and increase fluid intake as to reduce the risk of kidney
stone formation (Moe, 2018). Advice client to take caution and avoid driving since the drug
causes drowsiness.

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References
Aggarwal, K., Narula, S., & Tandon, C. (2016). Molecular mechanism of renal stone
formation and the critical role played by modulators. Biomed Res Int, 34(3), 1-21.
Kerry, H., Suzanne, C., Brenda, G., & Janice, R. (2014). Brunner & Suddarth's Textbook of
Medical-Surgical Nursing (13th Ed.). Philadelphia: Lippincott Williams & Wilkins.
Moe, W. (2018). Kidney stones: pathophysiology and medical management. Review. Lancet,
367, 333-344.
Pietroiust, A., Gomez, J., & Luzzi, L. (2017). Helicobacter pylori duodenal colonization is a
strong risk factor for the development of duodenal ulcer. Aliment Pharmacol Ther,
21(7), 909-915.
Randall, A. (2017). Recent advances in knowledge relating to the formation, recognition and
treatment of kidney calculi. Bull N Y Acad Med, 20, 473-484.
Sung, J., Yung, M., & Chiu, P. (2016). Causes of mortality in patients with peptic ulcer
bleeding: a prospective cohort study of 10,428 cases. Am J Gastroenterol, 105(1), 84-
89.