Question

Scenario (Page 588)

A 26-year-old woman in graduate school visits the family physician because for the past 3–4 months she has been experiencing gnawing pains in her upper-middle abdomen. When you ask her what seems to precipitate the pain, she is unable to say for sure. She says she feels the best in the early morning before eating. As the day progresses, she usually feels worse and takes Mylanta or Milk of Magnesia to relieve the pain. Sometimes, her pain is accompanied by severe diarrhea, and she has been tired, weak, and nauseous. In response to your question about stress, she tells you she is under extreme stress because she is preparing to defend her thesis for her Ph.D. She has been smoking more cigarettes than usual and drinking 6–8 cups of coffee each morning. In the evening, she often has a few glasses of wine to help her relax.

Critical thinking Questions

1. Based on this patient’s complaints, lifestyle, and use of OTC medications, what do you expect may be the cause of her initial complaint of upper-middle abdomen pain and her symptoms of fatigue, weakness, and nausea?

2. What diagnostic tests do you anticipate the physician ordering and for what possible diagnoses?

3. Instead of OTC antacids, what are the other choices for this patient to relieve her symptoms? Is there a class of medications you think might be the better choice for her? If so, what and why?

4. What type of teaching would you give the patient to better manage her problems?

Answer 1

1.Based on the patient's complaints, lifestyle, and use of OTC medications are caused the symptoms of pain. These factors causes significant changes in gastric mucosa. Firstly acute damage to the gasric mucosa can range from localized injury of superficial epithelial cells to destruction of the mucosa with mucosal congesion. After eating the gastric mucosa get irritant and shows the symptoms.

2.Endoscopic examination for direct viewing of gastric mucosa. Used to determine presence of gastric ulcer.

Tissue biopsy to rule out gastric carcinoma

Contrast studies to rule out gasric obstruction

Sample analysis of urine, blood and stool

• A complete blood count (CBC) may demonstrate anemia from blood loss or lack of intrinsic factor to confork ulcer bleeding.
• Stools are tested for occult blood and presence of infected sgent.
• Serum testd for antibodies to parietal cells and intrinsic factor

3.conservative therapy

• Adequate rest
• Cessation of smoking
• Stress management
• Dietary management: Avoid stimulant food items like caffeine containing beverages
• Eliminate alcohol consumption.

Drug therapy

a)Proton pump inhibitors- Reducing gastric acid secretion. Promote healing process. Eg, amoxicillin, clarithromycin

b)Histamine receptor blockers- promote healing process eg, famotidine, rantidine and cimetidine.

c)Antibiotics - To distruct pathogens growth in mucosa

4.

• Follow dietary modifications, including avoidance of foofs that may cause epigastric distress. This may include black pepper, caffeine containing drinks, spicy foods, and acidic foods.
• Reduce or eiminate alcohol intake.
• Avoid smoking
• Avoid OTC drugs unless approved by the health care provider.Many preparations contain ingredients such as aspirin, that should not be take ഉൻലെസ്സ് approved ബൈ health care provider.
• Use stress management techniaues.
• Report unusual symptoms