Posted: August 15th, 2022

Complaint of abdominal pain in the epigastric area

Complaint of abdominal pain in the epigastric area

A 65-year-old feminine involves the clinic with a grievance of abdominal pain in the epigastric area. The pain has been persistent for 2 weeks. The pain described as burning, non-radiating and worse after meals. Denies N&V, weight reduction or apparent bleeding. She admits to frequent belching with bloating.
PMH: seasonal allergy symptoms with Power Sinusitis, optimistic for osteoarthritis,
Meds: Claritin 10 mg po each day, ibuprofen 400-600 mg po prn pain
Household Hx-non contributary
Social historical past: Separated not too long ago pending divorce; annoying state of affairs with making an attempt to handle two properties. Works as a Authorized Helpant at a neighborhood legislation agency. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day, and 6-7 cups of espresso per day. She denies illicit drug use, vaping or unprotected sexual encounters.
Breath check in the workplace revealed + urease.
The healthcare supplier suspects the consumer has peptic ulcer illness.
Questions:
1. Clarify what contributed to the growth from this affected person’s historical past of PUD?
2. What’s the pathophysiology of PUD/ formation of peptic ulcers?

A 44-year-old morbidly overweight feminine involves the clinic complaining of “burning in my chest and a humorous style in my mouth”. The signs have been current for years however affected person states she had been treating the signs with antacid tablets which helped till the final four or 5 weeks. She by no means noticed a healthcare supplier for that. She says the signs worsen at evening when she is mendacity down and has needed to sleep with 2 pillows. She says she has began coughing at evening which has been interfering together with her sleep. She denies palpitations, shortness of breath, or nausea. A 44-year-old lady who’s morbidly overweight goes to the clinic and says, “My chest is burning and I’ve a humorous style in my mouth.” The signs have been there for years, however the affected person says she was treating them with antacid tablets, which helped till the final four or 5 weeks. She by no means went to a physician or nurse for that. She says the signs are worse at evening when she is mendacity down, so she has to sleep with two pillows. She says that she’s began coughing at evening, which is holding her from sleeping. She says she would not have coronary heart palpitations, shortness of breath, or nausea.
PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid weight problems (BMI 48 kg/m2)
FH:non contributary
Drugs: Lisinopril 10 mg po qd, Bentyl 10 mg po, ibuprofen 800 mg po q 6 hr prn
SH: 20 PPY of smoking, ETOH hardly ever, denies vaping
Diagnoses: Gastroesophageal reflux illness (GERD).
Question Assignment:
three. If the consumer asks what causes GERD how would you clarify this as a supplier?

Situation three: Higher GI Bleed
A 64-year-old male presents the clinic with complaints of passing darkish, tarry, stools. He acknowledged the first episode occurred final week, nevertheless it was solely a small quantity after he had eaten a dinner of beets and beef. The episode at the moment was accompanied by nausea, sweating, and weak point. He states he has had some mid epigastric pain for a number of weeks and has been taking OTC antacids. The more than likely analysis is higher GI bleed which gained’t be confirmed till additional endoscopic procedures are carried out.
Question Assignment:
four. What are the variables right here that contribute to an higher GI bleed?

Situation four: Diverticulitis
A 54-year-old schoolteacher is seeing your at the moment for complaints of passing vivid crimson blood when she had a bowel motion this morning. She acknowledged the first episode occurred final week. The episode at the moment was accompanied by nausea, sweating, and weak point. She states she has had some LLQ pain for a number of weeks however described it as “coming and going”. She says she has had a fever and abdominal cramps which have worsened this morning.
Analysis is decrease GI bleed secondary to diverticulitis.
Question Assignment:
5. What may cause diverticulitis in the decrease GI tract?

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