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What Does Persistent Epigastric Pain Indicate?
Question: A 28-year-old man is seen in a community clinic with the chief complaint of epigastric pain. He states he has the pain every day and has been present for 10 days. The pain is characterized as a dull burning sensation that increases about 2 hours after eating. He has had no nausea or vomiting. He denies having similar symptoms in the past.
He states that he is in good health. He takes only an occasional ibuprofen for headaches. He has taken two tablets three times over the past week. He drinks two beers at night with dinner.
On exam his abdomen is flat, soft, bowel sounds are present. He has mild tenderness with palpation of the epigastric area. No organomegaly or masses palpated. Vital signs are normal. BMI 35.
What conditions do you suspect this man may be suffering from?
He states that he is in good health. He takes only an occasional ibuprofen for headaches. He has taken two tablets three times over the past week. He drinks two beers at night with dinner.
On exam his abdomen is flat, soft, bowel sounds are present. He has mild tenderness with palpation of the epigastric area. No organomegaly or masses palpated. Vital signs are normal. BMI 35.
What conditions do you suspect this man may be suffering from?
Brief Answer:
Information
Detailed Answer:
Hello,
Are you studying to be a nurse practitioner or a physician?
My differential diagnosis would include:
gastritis secondary to NSAIDs (plus alcohol)
peptic ulcer disease (gastric or duodenal) secondary to NSAIDs or h. pylori
GERD
pancreatitis would be included on a Df/Dx but lower on my list
Information
Detailed Answer:
Hello,
Are you studying to be a nurse practitioner or a physician?
My differential diagnosis would include:
gastritis secondary to NSAIDs (plus alcohol)
peptic ulcer disease (gastric or duodenal) secondary to NSAIDs or h. pylori
GERD
pancreatitis would be included on a Df/Dx but lower on my list
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am currently in school to obtain my bachelor's degree in nursing. Thanks for asking.
What risk factors for GERD or ulcer disease should the nurse ask about during his or her nursing assessment?
What risk factors for GERD or ulcer disease should the nurse ask about during his or her nursing assessment?
Brief Answer:
Information
Detailed Answer:
Risk factors for peptic ulcer disease are tobacco use; drinking (in men - more than 2 drinks/dy, in women - more than 1 drink/dy); taking NSAIDs (aspirin, ibuprofen, naproxen, COX inhibitors); and sometimes corticosteroids. Also, a history of previous ulcers.
Risk factors for GERD are different than PUD. They include all of the things for PUD but also obesity, hiatal hernia, food intolerances, and many medications.
I'll add to my df/dx list - gall bladder disease, because although that typically presents with RUQ pain and burping, flatulence, I've also seen it present with gastritis/epigastric symptoms.
Information
Detailed Answer:
Risk factors for peptic ulcer disease are tobacco use; drinking (in men - more than 2 drinks/dy, in women - more than 1 drink/dy); taking NSAIDs (aspirin, ibuprofen, naproxen, COX inhibitors); and sometimes corticosteroids. Also, a history of previous ulcers.
Risk factors for GERD are different than PUD. They include all of the things for PUD but also obesity, hiatal hernia, food intolerances, and many medications.
I'll add to my df/dx list - gall bladder disease, because although that typically presents with RUQ pain and burping, flatulence, I've also seen it present with gastritis/epigastric symptoms.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
What history and physical examination findings given in the scenario above can increase this patient's risk of GERD or ulcer disease?
Brief Answer:
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Detailed Answer:
History:
GERD - burning sensation in throat, worse when lying down, heart burn, left sided chest pain, pain at bottom of sternum or left upper quadrant, burping, perception of reflux of food and acid, symptoms worse after large meals or spicy foods or alcohol; temporary relief from acid neutralizers such as calcium carbonate. Improvement after H2 blockers or PPIs.
PUD - many of the above symptoms but pain more likely to be epigastric or mid upper abdomen. Pain when stomach is empty and sometimes after eating (typically not as quickly as with GERD but can be). If there is ulceration, can have melana stools or coffee ground emesis or if a brisk bleed, bright red blood per rectum and hematemesis.
Information
Detailed Answer:
History:
GERD - burning sensation in throat, worse when lying down, heart burn, left sided chest pain, pain at bottom of sternum or left upper quadrant, burping, perception of reflux of food and acid, symptoms worse after large meals or spicy foods or alcohol; temporary relief from acid neutralizers such as calcium carbonate. Improvement after H2 blockers or PPIs.
PUD - many of the above symptoms but pain more likely to be epigastric or mid upper abdomen. Pain when stomach is empty and sometimes after eating (typically not as quickly as with GERD but can be). If there is ulceration, can have melana stools or coffee ground emesis or if a brisk bleed, bright red blood per rectum and hematemesis.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
While doing the physical assessment, what are important complications of ulcer disease the nurse should evaluate?
Brief Answer:
Information
Detailed Answer:
Well, I'm not trained as a nurse, so I don't know exactly what a comprehensive nursing assessment might entail, but one would look for if the patient looked weak, pale, in pain, dehydrated. And vitals - BP and pulse (BP might be low if the the patient is actively bleeding and pulse would be rapid from pain or dehydration); respiratory rate.
Information
Detailed Answer:
Well, I'm not trained as a nurse, so I don't know exactly what a comprehensive nursing assessment might entail, but one would look for if the patient looked weak, pale, in pain, dehydrated. And vitals - BP and pulse (BP might be low if the the patient is actively bleeding and pulse would be rapid from pain or dehydration); respiratory rate.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for your help I appreciate it. Best of wishes too you.
Brief Answer:
Your welcome and have a good night.
Detailed Answer:
I hope you do well on your assignment.
Best regards,
Bonnie Berger-Durnbaugh MD
Your welcome and have a good night.
Detailed Answer:
I hope you do well on your assignment.
Best regards,
Bonnie Berger-Durnbaugh MD
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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