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What Causes Pain Upper Stomach?
Question: i am a student studying for my Master's degree as an APN and I have a 67 yr old female patient with pain in the upper middle section of her stomach. She says she feels like a hot poker is stabbing her. I suspect a Peptic Ulcer. She is taking 500mg Tums and no OTC meds. She also had CAD x 1 year; no stents, stable angina with non-ST segment elevation. I have to develop a Health and Assessment Plan for her. Should I refer her to a Gastro for endoscopy??? Should I address the CAD in my plan or just keep it as Past History. I don't know if it needs to be mention and or reviewed in my Health and Assessment Plan. Please help
Brief Answer:
Yes, needs reference and inclusion in plan
Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Prakash HM and I will be answering your query.
Based on your query, my opinion is as follows:
1. Yes, you need to refer her to Gastro for endoscopy to look for any reflux changes or peptic ulcer.
2. CAD is still ongoing, and needs to be included in the health and assessment plan. As it is not treated completely and only stabilized partially, it needs to be reviewed in health and assessment plan.
Hope it helps.
Any further queries, happy to help again.
Dr. Prakash HM
Yes, needs reference and inclusion in plan
Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Prakash HM and I will be answering your query.
Based on your query, my opinion is as follows:
1. Yes, you need to refer her to Gastro for endoscopy to look for any reflux changes or peptic ulcer.
2. CAD is still ongoing, and needs to be included in the health and assessment plan. As it is not treated completely and only stabilized partially, it needs to be reviewed in health and assessment plan.
Hope it helps.
Any further queries, happy to help again.
Dr. Prakash HM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much for your response. However, I am stuck on the CAD what should my Plan be for her??? She was diagnosed 1+ yr ago. Has had no other signs or symptoms. Takes 325 aspirin daily; has borderline Choles 210, Takes Simvastatin 40 mg, poor diet, exercises sometimes. I don't know what happened that she was diagnosed with CAD. Should she be referred out to a Cardiologist??? Should I order a stress test
Brief Answer:
Stress test and clopidogril with low dose aspirin.
Detailed Answer:
Hi,
Thanks for asking again.
At this age, irrespective of previous CAD, a cardiologist opinion is always necessary. With history of angina, she will require cardiologist opinion. AS ECG changes are minimal, stress test, will be necessary for cardiologist to look for any changes.
Diet modification and regular exercises needs to be advised. In view of peptic ulcer, anti-platelet agents like clopidogril may be necessary and aspirin dose may need to be reduced.
Hope it helps.
Any further queries, happy to help again.
Dr. Prakash HM
Stress test and clopidogril with low dose aspirin.
Detailed Answer:
Hi,
Thanks for asking again.
At this age, irrespective of previous CAD, a cardiologist opinion is always necessary. With history of angina, she will require cardiologist opinion. AS ECG changes are minimal, stress test, will be necessary for cardiologist to look for any changes.
Diet modification and regular exercises needs to be advised. In view of peptic ulcer, anti-platelet agents like clopidogril may be necessary and aspirin dose may need to be reduced.
Hope it helps.
Any further queries, happy to help again.
Dr. Prakash HM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
You are being very helpful, than you so much. She IS on Plavix 75 mg daily What is clopidogril? Platlet count is Plt 320 x 103/mm3., Hct 30%., Hgb 9.8g/dL.,
Brief Answer:
Plavix is clopidogrel
Detailed Answer:
Hi,
Thanks for asking again.
Plavix is clopidogrel. If she is already on it, it should be continued.
Hemoglobin is bit low. Depending on MCV, appropriate management plan. Low MCV, include iron therapy. High MCV, include vit B12 and folic acid therapy.
ECG is necessary in both. Chest X-ray may not be necessary, as she is good respiratory system wise and unnecessary exposure to radiation needs to be avoided.
Hope it helps.
Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answers.
Dr. Prakash HM
Plavix is clopidogrel
Detailed Answer:
Hi,
Thanks for asking again.
Plavix is clopidogrel. If she is already on it, it should be continued.
Hemoglobin is bit low. Depending on MCV, appropriate management plan. Low MCV, include iron therapy. High MCV, include vit B12 and folic acid therapy.
ECG is necessary in both. Chest X-ray may not be necessary, as she is good respiratory system wise and unnecessary exposure to radiation needs to be avoided.
Hope it helps.
Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answers.
Dr. Prakash HM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
SCr-0.7mg/dL, MCV- 72um3, Ca 9.5 mg/dL., MG 2.3 mEq/L., Phos 3.6 mg/dL., Albimin 4.8g/dL., Fe 49 mcg/dL.,
Thank you again, DR.
Hi Dr:
Do you think with her lab numbers she needs Iron, B12, and Folic acid therapy???
Thank you
Thank you again, DR.
Hi Dr:
Do you think with her lab numbers she needs Iron, B12, and Folic acid therapy???
Thank you
Brief Answer:
Low MCV requires therapy with iron
Detailed Answer:
Hi,
Thanks for asking again.
MCV is low, along with Fe on the lower side. Needs therapy for low MCV. Iron deficiency common cause.
Get a reticulocyte count. If it is more than 4-5%, then therapy maybe not necessary. If low, will require therapy.
B12 and folic acid therapy is not needed at present.
Hope it helps.
Any further queries, happy to help again.
Dr. Prakash HM
Low MCV requires therapy with iron
Detailed Answer:
Hi,
Thanks for asking again.
MCV is low, along with Fe on the lower side. Needs therapy for low MCV. Iron deficiency common cause.
Get a reticulocyte count. If it is more than 4-5%, then therapy maybe not necessary. If low, will require therapy.
B12 and folic acid therapy is not needed at present.
Hope it helps.
Any further queries, happy to help again.
Dr. Prakash HM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Retic is 0.4% so not needed correct? You are so helpful
Brief Answer:
Reticulocyte count low. Therapy necessary
Detailed Answer:
Hi,
Thanks for asking again.
Reticulocyte count of 4-5% is necessary with this amount of anemia.
0.4% is low. Its definitely iron deficiency.
Will require therapy with iron.
After two weeks of therapy, reticulocyte count, if repeated would be increased. This confirms importance of iron therapy.
Hope it helps.
Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answer.
Dr. Prakash HM
Reticulocyte count low. Therapy necessary
Detailed Answer:
Hi,
Thanks for asking again.
Reticulocyte count of 4-5% is necessary with this amount of anemia.
0.4% is low. Its definitely iron deficiency.
Will require therapy with iron.
After two weeks of therapy, reticulocyte count, if repeated would be increased. This confirms importance of iron therapy.
Hope it helps.
Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answer.
Dr. Prakash HM
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
hello Dr. and thanks again. A few last questions. The patient takes 1 Centrum Silver daily. Does she need to take Vit D 500 mg daily and/or Calcium 600-1200 mg daily because of her age?
Also, I don't know...Does CAD show up on an ECG or just a stress test?? If so what would I be looking for??
One more thing...Should I prescribe Prevacid 40 mg po daily for 2 weeks; WITH dietary changes, and if that doesn't help refer her to the endo???
Lastly, when, if I am going to, refer her to a cardiologist. Can I send her for the stress test and then send her to the cardiologist with the results?? How should she be treated now?? Just with the Plavix 75mg and diet and exercise?
Thanks so much.
Also, I don't know...Does CAD show up on an ECG or just a stress test?? If so what would I be looking for??
One more thing...Should I prescribe Prevacid 40 mg po daily for 2 weeks; WITH dietary changes, and if that doesn't help refer her to the endo???
Lastly, when, if I am going to, refer her to a cardiologist. Can I send her for the stress test and then send her to the cardiologist with the results?? How should she be treated now?? Just with the Plavix 75mg and diet and exercise?
Thanks so much.
Brief Answer:
Look into essential medicines.
Detailed Answer:
Hi,
Thanks for asking again.
Vit D and calcium supplements are not compulsory, but required if bone mineral density is low or she has bone pains. Addition of non-essential extra medications in the elderly could make them averse to medications or make them skip essential medications. So, age alone should not be criteria, need is important too.
CAD will require a stress test. Need to watch for any ST or QRS changes. Arrythmias, chest pain, blood pressure variation also needs to be looked into.
Prevacid for 2-3 weeks should be helpful. Also dietary changes and life style changes, like avoiding stress, multiple small meals, low spicy diet etc would be helpful. It should help, if not, further opinion maybe taken for gastro or endo consultant as necessary. Need to watch for medication induced gastritis and to be adjusted in relation to food, or as necessary.
Better to get a stress test, and based on findings, can refer to a cardiologist. At present, Plavix 75 mg, with diet and exercise should be adequate.
Hope it helps.
Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answer.
Dr. Prakash HM
Look into essential medicines.
Detailed Answer:
Hi,
Thanks for asking again.
Vit D and calcium supplements are not compulsory, but required if bone mineral density is low or she has bone pains. Addition of non-essential extra medications in the elderly could make them averse to medications or make them skip essential medications. So, age alone should not be criteria, need is important too.
CAD will require a stress test. Need to watch for any ST or QRS changes. Arrythmias, chest pain, blood pressure variation also needs to be looked into.
Prevacid for 2-3 weeks should be helpful. Also dietary changes and life style changes, like avoiding stress, multiple small meals, low spicy diet etc would be helpful. It should help, if not, further opinion maybe taken for gastro or endo consultant as necessary. Need to watch for medication induced gastritis and to be adjusted in relation to food, or as necessary.
Better to get a stress test, and based on findings, can refer to a cardiologist. At present, Plavix 75 mg, with diet and exercise should be adequate.
Hope it helps.
Any further queries, happy to help again.
If you do not have any further queries, you can close the discussion and rate the answer.
Dr. Prakash HM
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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