Scene 1: At the Doctor’s Office
Doctor (D): Hi! Please come in and take a seat.
Patient (P): Good morning, Doctor. Thanks.
D: How do you feel yourself today?
P: Better, but I’ve still got a stomach ache.
D: Right. You see, when you came here 4 days ago and were unable to breathe on your own, we had to attach you to a respirator and ventilate your lungs in the ICU.
P: Yes, I remember that. But what is the ICU you are talking about?
D: ICU stands for the intensive care unit, which we use to treat seriously ill patients. You see, you were gasping for breath, and we had to put you in the ICU.
P: Got it. So what’s wrong with me?
D: I’m still not sure about the final diagnosis, we will need to run some tests and monitor your health for about a week.
P: I see. But what is going on with my stomach? It aches a lot, and as I understand, it has nothing to do with breathing problems.
D: Right. It seems that you have a stress ulcer. Did you take any painkillers recently?
P: Yes, I was feeling myself very bad last week and may have taken too many painkillers.
D: And that is the problem. When you overuse painkillers, it may promote the development of ulcers, and this is probably what has happened.
P: Doctor, this is the first time I hear about ulcer. Can you tell me more about it?
D: Sure. You overused painkillers, and together with a strong psychological stress, an ulcer has developed, and this is very positive that you had no gastrointestinal bleeding. This so-called gastrointestinal bleeding is a bleeding that could take place in your stomach, and you are very lucky you had none. Otherwise, the whole situation could have been much worse.
P. That’s good, but I still don’t really get it.
D. Stress ulcers are defined by hemodynamic instability, which is inability of the organism to maintain a normal blood pressure, and by overt bleeding.
P: But what causes ulcers?
D: Usually, when someone has Helicobacter pylori, a type of a bacteria that lives in the digestive tract, it causes sores in the lining of the stomach, and such sores are called ulcers. Stress can be the main reason why you got an ulcer, but most probably, you are also infected with Helicobacter pylori.
P: And what is the mechanism how this ulcer is developed?
D: Firstly, you get the Helicobacter pylori with water or food, and it later attacks the lining of your stomach. It results in a serious damage to the lining of the stomach, and acid gets through the lining. Most probably, the attack of the bacteria happened because you faced too much stress recently, so we can state that stress is the reason you got this stress ulcer.
P: If ulcer is just a stomachache, why are you co concerned about it? Why can’t I just take some pills?
D: Stress ulcer is rather serious, as there are some risks connected to the formation of stress ulcer. You are at risk of staying longer at the ICU. Also, patients with stress ulcer in some cases are at risk of having a higher mortality rate.
P: I still don’t get how it works.
D: Have you heard about gastritis?
P: Yes, I suffered it for 2 years some time ago.
D: The mechanism is almost the same. A mucosal blood flow is reduced, some of the defense mechanisms are down, and you get the risk to be injured by pepsin and acid.
P: Got it. And what about ulcer treatment?
D: I’m sorry to tell you this, but if you have an ulcer, it is most likely that you will have a bleeding. To prevent it, we will have to check and fix your acid-base balance. Then we will also have to use the combination of various medications and infusion of vasopressin, which is a kind of a hormone. I’m afraid you will have to stay for at least a week at the hospital.
P: And what if I have a bleeding?
D: We can shunt the blood away, but then you will be at risk of getting your mucous membrane injured, so I will not recommend it. We can also stop active bleeding by H2-blockers and various antacids.
P: What are those?
D: H2 blockers are the medications that block the actions of histamine, or to put it simply, H2 blockers reduce acid. Antacids are also medications that neutralize the acidity in the stomach, which prevents further bleeding.
P: I see. Well, seems that I have no other choice.
D: I’m afraid that is so. Let me sum everything up for you. You have a stress ulcer, and the main reason you have it is that you are seriously ill and you are under significant physiologic stress. So, the more rest you have now, the better.
P: Thank you, doctor.
D. See you in about 30 minutes.
