Question

A 71-year-old Hispanic woman has been presented with a 4-week history of abdominal pain and dyspepsia. She tells that she has occasional heartburn for years but she does not recall about having abdominal pain. Her chief complaint is pain in stomach due to which she wakes up while sleeping and bloating and belching post meals. This pain started soon after she visited her sister, a nurse at a mission in Nicaragua.

She also informs about having arthritis for which she is taking Motrin every day for past 2 years and also take Tums extra strength a couple of times a day for her stomach pains. Her vital signs are 118/70 blood pressure (BP), 90 beats per min heart rate (HR), 18 breaths per minute respiratory rate and body mass index (BMI) of 29.

Q1what are the differential diagnosis that you are considering?

Q2what lab test will help you rule out some of the differential Dx?

Q3 What is your treatment and specific information on the Rx you will give to this patient?

Answer 1

Q1, Differential diagnosis:
-Functional dyspepsia
-Gastritis
-Peptic ulcer
-celiac disease
-Gastroesophageal reflux disease(GERD)
These all the differential diagnosis patients will have the same symptoms like abdominal pain, bloating, belching, heartburn, etc.
Q2, Lab test:
- Helicobacter pylori testing to rule out infection
- Stool test to look for H.pylori infection
-serum electrolytes
-complete blood count
Q3, Treatment:
-Histamine-2 receptor antagonist(H2RAs) like ranitidine, Cimetidine and
-proton pump inhibitors(PPIs) blocks the effects of histamine that stimulates certain cells in the stomach to produce acid. It is an effective therapy to reduce symptoms and healing and preventing damage to the esophagus.
-Pain medicine
-low doses of antidepressant medications can reduce the symptoms
Patient diet and lifestyle modification can change the symptoms
-Advice the patient to avoid certain food like milk, coffee, fatty or fried foods, mint, citrus fruits, and some spices.
-Advice the patient to elevate her head end while sleeping.
-Tell her to eat small and frequent meals.
-Advice to avoid lying down as soon as having foods
- Advice patient to reduce the weight.
-Advice the patient to do mild exercise and activity to improve digestion.
-Advice patient to avoid outside foods.