Question

Jacob is a 45-year-old Construction foreman who presents to the clinic complaining of gastric distress and an associated lightheadedness. He is also experiencing excruciating intermittent pain in his kidney area radiating across his abdomen and into his genital area. Jacob has been treated for hypertension for five years but denies any known cardiac history. He was diagnosed with Diabetes Type II last year for which he takes metformin. His weight is stable, and he claims to have an excellent appetite. He has a normal bowel habit and has not seen and black stools, but he hasn't looked. He has noticed an increased frequency of urination and a moderate amount of hematuria. Denies any previous surgeries. Upon further questioning, he states that his stools are not only black but are sticky and smell bad. He further complains of recent worsening of a chronic epigastric burning which had been a problem off/on for years. He had doubled his usual dose of Tums without significant relief of the burning. He has 2-3 beers after work and sometimes a cocktail before dinner. He takes NSAIDs as needed for back pain and recently started on one aspirin per day for cardiac prophylaxis. He smokes two packs of cigarettes per day and an occasional cigar. He was told of an ulcer in the distant past but had no specific evaluation or treatment for same. positive CVA, positive H. Pylori. What is his diagnosis?

Answer 1

DIAGNOSIS: RENAL CALCULI WITH PEPTIC/GASTRIC ULCER

PEPTIC ULCER: is an open sore in the digestive tract that affects both the stomach and small intestines mainly caused by two factors a) Helicobacter pylori and b) nonsteroidal anti-inflammatory drugs(NSAIDS) such as aspirin.

SYMPTOMS OF PEPTIC ULCER includes a) heartburn b) abdominal pain c) lightheadedness d) fatigue e)stool that is black and sticky e) hemorrhage and f) gastric distress. In addition to this, the risk of developing an ulcer caused by NSAIDs is greater if the patient a) drink alcohol b) take them too frequently c) have had ulcers in the past.

RENAL CALCULI/ KIDNEY STONES: Kidney stones are hard collections of salt and minerals often made up of calcium and uric acid. Stones are more common in men and those who have diabetes because of excess urine output and is caused by less intake of water.

SIGNS AND SYMPTOMS: a) pain in the back may radiate to abdomen and genital area b) hematuria (blood in urine) . In addition to this, positive CVA ( costovertebral angle tenderness ) is a medical test in which pain is elicited by performing percussion of the area of the back overlying the kidney which disturbs the inflamed tissue , causing pain. This test is positive in people with renal stones.