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History of mid-epigastric pain. Noticed dark stools. Taking TUM. Treatment? Guidance?

Dec 2012
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Answered by

General & Family Physician
Practicing since : 2012
Answered : 1704 Questions
55 y/o obese female presents with 2 to 3 months history of mid-epigastric pain that is worse after eating. She is unable to identify any specific foods that may be triggering the symptoms. She denies excessive gas, denies regurgitation of food or a water brash. She has normal daily bowel movements but states that sometimes her stools are very dark. Denies vomiting. She has no previous history of these symptoms and they are becoming disruptive in her daily life. She has been taking TUMs, �like they are candy.�

VS: BP 144/92, P 88, R 18, T 98.6, ht 5�2�, wt 220, BMI 40
1.What additional history would you like for this patient?
2.If you plan to start drug treatment today
a.what is your choice, and dose, and for how long
b.what are some alternatives to this choice
c.what is your rationale for this choice
3.How will you evaluate effectiveness of treatment and when?
4.What risk factors will guide your choice?
5.Are there any major drug-to-drug interactions, SE�s or adverse reactions to this drug?
6.What patient education regarding the use of this drug and the plan of care would you give?
7.Besides drug therapy, are there any other interventions you would consider or recommend
Posted Tue, 16 Jul 2013 in Abdominal Pain
Answered by Dr. Nsah Bernard 2 hours later
Thanks for the detailed description and specific follow-up questions.

I am Dr. Nsah and I am pleased to be able to assist you with your query.

Looking at your description, ww can say that she is obviously suffering from a peptic ulcer diseases or chronic gastritis or other. which might have become complicated with probable digestive hemorrhage (since you mentioned dark stool/melena from time to time). Looking at her vital signs they seem pretty much normal besides her slightly elevated blood pressure (which could have resulted as stress-induced). Now to answer your questions:
1- I will like to know if she has been on any medications lately such as NSAID or steroidal antiinflammatory, smoking, alcohol etc. If she is free of those it will be best if an H. pylori test be done (this is the most frequent cause of PUD)
2- drug choice depends on cause of PUD but for most PUD trearment choice is PPI (such as omeprazole, lanzoprazole etc) associated to antacids (such as aluminium hydroxide). Other drug choices could be H2 inhibitors such as cimetidine, ranitidine etc. The PPIs could be associated to antibiotics such as amoxicillin + clarithromycin to eradicate the h. pylori. there are various dosages but you will need a physician to give you an actual prescription. Antispasmodic can be associated as personally those are my combinations.
3- efffective is evaluated with pain alleviation upon initiation of treatment. Clearer stool too.
4- Risk factors are the ones mentioned. use of nsaid smoking alcohol h.pylori infection etc.
5- Most of them hardly come with side effects besides the antibiotica. drug interaction will have to be checked with other medications she is taking already.
6- she should avoid all the above mentioned risk factors, avoid too much spicy food especially with pepper, avoid starvation and make sure to follow treatment till the end ones initiated.

Thanks and hope this helps

Dr. Nsah
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