Question

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. she has been diagnosed as peptic ulcer, mainly gastric ulcer. she has been experiencing gnawing pain in upper middle abdomen ususally after consumption of food along with nausea, fatique, weakness. and she takes milk of magnesia in order to relieve to pain. she has been under stress due to her project. she consumes smoking than usually and drinks coffee 6-8 cups in the morning. pain in the gastric ulcer usually occur after eating whereas pain duodenal ulcer usuallyoccur before consumption of food and get relieved after eating of food.

2. as she has been experiencing pain, weakness, fatique, the folloing test can be ordered, which are Complete blood count in order to rule anemia. stools can be tested for testing of nay occult blood. she is experiencing diarrohea may be due to side effects of mik of magnesia, gastric changes,thereby she is tested for electrolyte changes.serum amylase test is also advised for her. endocopy can be performed to rule out gastric ulcer or duodenal ulcer, look for any changes, lesions, tissue are taken too find out H. pylori infecrtion.

3.instead of over the counter medication, she has been commencd on histamine receptor antagonist or H2 receptor antagonist in order to decrease acid secretion in the stomach by blocking the action of histamine on the histamine receptors on the parietal cells in the stomach. example are ranitidine, famotidine

proton pump inhibitors such as omeprazole, decrease acid secretion by reducing the hydrogen potassium adenosine triphosphate pump on the surface of parietal cells.

Cytoprotective agents such as sucralfate, protect mucosal cells by forming protective layer at the site of ulcer and stopping of digestion by pepsin.

if she is tested positive for H. pylori infcetion she may be prescibed for antibiotic such as amoxicillin along with metronidazole and proton pum inhibitor

she may be commenced on proton pump inhibitor which is more potent than histamine 2 receptor antagonist in order to reduce her gastric secretion. she may be commenced on cyto protective agents, has less sideeffcets which protect the layer of stomach or antacid.if she prescribed for antacid, check for sideeffects.

4.she was advised for stress reducaton technique such as deep breathing technique, mediatation, yoga

advise not to take over the counter mediaction which contains many componenets that cause side effects

instruct to reduce smoking habits and coffeine intake which are  one of the risk factors for ulcer by increasing acid secretion.

explain need for consuming bland dietwhich has low spicy. avoid milk, cream products which stimulates acids

explain to report health provider if she has following symptoms such as blood in stools, vomiting

educate her to follow medication order as said by health provider

advise to come for folow up to see for her improvement.