Factors That Contribute to Ulcers and the Significance of Urease and Biopsy Results

read the below case and answer to the questions make sure you cite your reference. one of the references should be
Arcangelo, V.P., & Peterson, A.M. (2022). Pharmacotherapeutics for advanced practice: A practical approach (5th ed.). Wolters Kluwer. ISBN 978-1-9751-6059-3. APA style .
Mr. MS is a 55-year-old male presents to the office with complaints of a 4-week history of gradually increasing abdominal pain. He complains of increased pain about 2 hours after meals and unintentional weight loss of 10 pounds in the last 2 months. When asked to localize the pain, he points to the epigastrium. He says that the pain was previously improved after drinking milk or taking tums. He now says that milk or antacids are no longer effective in relieving the pain. He rates his pain as a 7 out of 10. He denies radiation of the pain to the back, jaw, or arm. His symptoms are not associated with any particular foods. He denies nausea/vomiting/constipation/diarrhea, dyspnea, or chest pain. He has regular bowel movement, but notes that they are “dark” on occasion. He complains about increasing fatigue.
His PMH is significant for osteoarthritis of the right knee, HTN managed with diet & exercise, and migraine headaches. His PSH is significant for cholecystectomy about 6 years ago.
His current medications include:
aspirin 325 mg daily (which he takes one his own due to a family history of CV disease)
ibuprofen 400 mg BID for the last 18 months
tums as needed.
He denies any other prescription or OTC medications.
He has a documented allergy to penicillin with a reaction of dyspnea and rash.
Social history:
Recently unemployed as an insurance salesman. His unemployment benefits have lapsed.
He is a widow and lives alone.
(+) smoking – 1 ½ PPD (15 pack year history).
Denies illicit drug use.
He denies routine use of alcohol but states he does enjoy a “couple” beers during the Bills games.
Physical Exam:
VS: afebrile, P. 90 regular, R. 18 unlabored, BP 156/98.
Patient is alert & oriented. Skin is pale, patient in mild distress rubbing abdomen. Sclera anicteric
Lungs clear, CV S1S2 RRR
(+) bowel sounds in all quadrants. Abdomen soft, (+) Epigastric tenderness with palpation, no rebound or guarding
Diagnostics:
CMP/LFTs – WNL
CBC – Hgb/Hct 12/36. No leukocytosis
Stool heme-positive
Rapid urease test positive
Given the current symptoms, you order and endoscopy and biopsy.
Endoscopy: 1 cm duodenal ulcer with evidence of recent bleeding but no evidence of acute hemorrhage in the ulcer crater.
Biopsy positive for Helicobacter pylori.
Answer the following questions:
Identify at least four factors that contribute to ulcers in MS.
What is the significance of the urease test result?
What is the significance of the biopsy result?
What type of management would be appropriate for MS?
How would you treat MS hypertension?