CASE PRESENTATION ON

APD/APHTHOUS STOMATITIS

PRESENTED BY - VARSHA KUNWAR RAJPUT

[PHARM D 4th YEAR]
 APD[ACID PEPTIC DISEASE]
Acid peptic disease, also known as acid-related disorders, encompasses a group of
conditions characterized by the abnormal production of gastric acid and its impact on the
gastrointestinal tract. The primary components involved in acid peptic disease are gastric
acid, pepsin, and the mucosal barrier.
What Causes Peptic Acid Disease?
Peptic acid disease is primarily caused by factors such as Helicobacter pylori infection,
long-term use of NSAIDs, and, in some cases, excessive stress. These elements disrupt
the balance of stomach acid, leading to conditions like gastritis, peptic ulcers, and GERD.
Identifying and addressing these causes are crucial for effective management.
 Helicobacter pylori (H. pylori) Infection: A common bacterial infection that can lead to
gastritis and peptic ulcers.
 Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Prolonged use of NSAIDs like
aspirin or ibuprofen can irritate the stomach lining.
 Stress: Though not a direct cause, stress can exacerbate symptoms of acid peptic
disease.
 SIGNS AND SYMPTOMS:
Symptoms of acid peptic disease can vary, but common signs include:
Dyspepsia: Discomfort or pain in the upper abdomen.
Heartburn: Burning sensation in the chest due to stomach acid reflux.
Nausea and Vomiting: Especially after meals or when lying down.
Regurgitation: Sour taste in the mouth from stomach contents flowing back.
Belching and Bloating: Excessive gas and a feeling of fullness.
Weight Loss: Especially in cases of severe or chronic conditions.
Bloody or Dark Stools: Sign of bleeding in the gastrointestinal tract.
Difficulty Swallowing: Particularly in cases of esophageal involvement.
APHTHOUS
STOMATITIS
Aphthous stomatitis, also known
as a canker sore, refers to small,
painful ulcers that can appear on
the inside of the lips, cheeks,
or soft palate; on the floor of the
mouth; on the gingiva of the
teeth; or on the tongue.
 CASE SUMMARY: A 59 years old male patient was admitted
in general medicine-male ward of GMCH with chief complaints of
pain in abdomen , burning sensation since 1 month and oral ulcer
since 2 months.

SUBJECTIVE EVIDENCES:
DEMOGRAPHIC DETAILS-
IPD NO.- 980818
AGE - 59 years
DOA – 29/7/2024
SEX - MALE
HEIGHT - 165cm
 CHIEF COMPLAINTS:
Pain in abdomen × 1 month
Burning sensation × 1 month
oral ulcer × 2 month

OBJECTIVE EVIDENCES:
>> VITALS-
TEMP. – 98.1°F
PULSE – 86 bpm
RR – 12bpm
BP – 110/80 mmHg
>>GENERALS -
CNS- conscious and oriented to T/P/P
CVS- S1 S2 heard
GIT- soft and non-tender
>>LABORATORY FINDINGS:
COMPLETE BLOOD 29/7/2024 BIOLOGICAL REF.
COUNT RANGE
HB 14.10 12-15g/dl

RBC 4.61 4.5-6.2 million/cumm

WBC 4.50 4000-11000/cumm

NEUTROPHILS 50.10 40-75%

LYMPHOCYTES 38.30 20-45%

MONOCYTES 7.80 2-8%

EOSINOPHILS 3.70 1-6%

BASOPHILS 0.10 0.1%

PLATELET 246.00 150-450 thousands/cumm

RENAL FUNCTION 29/7/2024 BIOLOGICALL REF.
TEST RANGE
SR. CREATININE 0.67*L 0.9-1.4 mg%

THYROID MARKERS 29/7/2024 BIOLOGICAL REF.

RANGE
TSH 1.030 0.3-6.0

LIVER FUNCION TEST 29/7/2024 BIOLOGICAL REF.

RANGE
SGOT(AST) 33.00 <40ml
>>OTHER INVESTIGATON:
VITAMIN B12 – 538.00 pg/ml
BLOOD SUGAR RANDOM – 84.00 mg/dl
CHEST X-RAY – WNL
USG W/A –
-No free fluid is seen in peritoneal cavity
-Grade I fatty liver changes
ASSESSMENT:
On the basis of subjective and objective evidences the patient was
diagnosed with APD(acid peptic disease) and aphthous stomatitis.
 MEDICATION PLAN
SR. DRUG DOSE FREQUENCY STD. INDICATION DAYS OF
NO DOSE TREATMEN
. TRADE GENERIC T
NAME NAME
1. INJ. VITAMIN B 1 amp 1-0-0 NUTRITIONA 29/7/24 –
OPTINEURO COMPLEX WITH L 1/8/24
N VITAMIN B12 SUPPLEMENT
S
2. INJ. PANTOP PANTOPRAZOLE 40mg 1-0-1 40mg/ PPIs 29/7/24 –
day 1/8/24

3. INJ. PERISET ONDANSETRON 4 mg 1-1-1 0.15mg/ ANTI-EMETIC 29/7/24 –

kg 1/8/24

4. TAB. FOLIC ACID 5mg 1-0-0 FOLIC ACID 29/7/24 –

FOLVITE SUPPLEMENT 1/8/24
S
5. LIQ. 2 Tsp 1-1-1 ANTACIDS 29/7/24 –
MUCAINE 1/8/24
GEL
 PHARMACIST NOTE
DOSE – IT WAS NOT MENTIONED PROPERLY
FREQUENCY – IT WAS MENTIONED PROPERLY
NO DRUG – DRUG INTERACTION WERE FOUND
 PATIENT COUNSELLING:
 Keep a food diary. Limit trigger foods and beverages such as chocolate, fried food,
peppermint, spicy foods, pizza, processed foods, fatty meats or cheese, tomato-based
sauces, citrus fruits, chocolate,coffee, and carbonated beverages, as well as alcohol and
tobacco.
Sit up straight while eating. Eat smaller, more frequent meals instead of a few large
meals. Do not lay down for at least 2 to 3 hours after a meal .
Avoid late night snacks.
Lose weight.
Drink more water. Have plenty before and during exercise.
Elevate the head while sleeping. Raise the head of the bed 6 to 8 inches by safely
putting blocks under the bedposts. Patients can use extra pillows in addition to this.
Maintaining good oral hygiene is essential to allow the healing of the lesions. Regular
brushing with a soft-bristled toothbrush and using a mild antiseptic mouthwash.
 Avoid irritating substances, such as certain toothpaste ingredients or acidic foods, that
can worsen aphthous stomatitis symptoms.