GI Conditions Part 1 PDF

Gastrointestinal conditions  Case 1 The patient is a 45 year old male with a history of eight weeks complaint of heart burn that worsens with lying down after dinner. The patient states that the pain lasts thirty minutes to two hours, and that it wakes him...

Gastrointestinal conditions  Case 1 The patient is a 45 year old male with a history of eight weeks complaint of heart burn that worsens with lying down after dinner. The patient states that the pain lasts thirty minutes to two hours, and that it wakes him at night. Patient reports taking Maalox up to five times daily, however these only help for a short time. Medical History No Known Allergies ,Hypertension for two years ,Rheumatoid arthritis in hands and feet for one year. Social History Patient is married with three children. Patient drinks two beers daily for the past twenty years and smokes one pack per day for twenty years. Current medications Prednisone 20 mg orally daily Diltiazem 240 mg orally daily Piroxicam 30 mg orally daily Multi- vitamin one orally daily. On Asking him about his food he reported that he eats too many chocolates in his day and eating fast food 4 times per week. His endoscopy reveals no gastric ulcer.  Case 1 1- What do you think the patient is suffering from? And why? 2- What do you think are the differences between Dyspepsia, heart burn and GERD? 3- What are the risk factors for this patient? 4- What will be your action? Explain your answer 5- When to refer dyspepsia?  CASE 2 You have been asked to recommend a ‘strong’ mixture for heartburn for Mr Ahmed , a local man in his late 50s who works in a nearby warehouse. Mr Ahmed tells you that he has been getting terrible heartburn, bloating, and nausea. For which his doctor prescribed a liquid alginate preparation about 1 week ago. The problem is no better. When asked if he can point to where the pain is, Mr Ahmed gestures across his chest and clenches his fist when describing the pain, which he says feels heavy. You ask whether the pain ever moves and Mr Ahmed tells you that sometimes it goes to his neck and jaw. Mr Ahmed is a smoker and is not taking any other medicines. When asked if the pain worsens when bending or lying down, Mr Ahmed says it does not, but he tells you he usually gets the pain when he is at work, especially on busy days.  Case 2 1- What do you think the patient is suffering from? Justify your answer 2- What is the most likely cause in this case? Explain yor answer 3- What will be your action? Explain your answer  Case 3 A 33-year-old male presents with a one-month history of episodes of mid-epigastric pain, a “burning” sensation in his chest, an associated dry cough, and occasional regurgitation. The pain worsens after eating and when he is lying flat. The patient has increasing postprandial fullness and early satiety. He also states waking up from the pain and burning, with a sore throat and hoarse voice. The patient reports associated mid-thoracic, bilateral back pain that occurs during the episodes.  Case 3 The symptoms are partially relieved by adjusting from a lying to a sitting position and with the use of over-the-counter (OTC) medications Maloox® and Antodine. The patient has been a marketing manager for a mid-size company for eight years. He does not smoke, use any medication or drugs other than an occasional OTC, and is a social drinker only.  Case 3 1- What do you think the patient suffering from ? explain your answer 2- What will be your action? Justify your answer 3- What are the causes of referral ?  Case 4 Mrs Sarah is a woman aged about 50 years who wants some advice about a stomach problem. On questioning, you find out that sometimes She gets a burning sensation just above the breastbone and She feels the burning in her throat, often with a bitter taste, excessive saliva in her mouth, and a regurgitation of gastric contents. The discomfort is worse when in bed at night and when bending over whilst gardening. She has been having the problem for 1 or 2 weeks and has not yet tried to treat it. Mrs Sarah is not taking any medicines from the doctor. You ask Mrs Sarah if the symptoms are worse at any particular time and she says they are worst shortly after going to bed at night.  Case 4 What do you think the patient suffering from ? explain your answer What will be your action? Justify your answer  Case 5 A 42-year-old man with the chief concern of sharp and constant epigastric pain for the past 2 weeks. He states that the pain is associated with bloating and nausea. This pain is often worse with eating and that it is present at least 5 days/week. He states that although he initially tried OTC antacids with some relief, the pain returns about 3 hours after each dose. He currently takes no other medications. He reports no any drug allergy. His endoscopy reveals an ulcer. He has done a urea breath test (UBT), the result of which is positive.  Case 5 1. What do you think the patient is suffering from ? explain your answer 2. What is the Classification of Peptic Ulcer Disease (PUD)? 3. What is the most likely cause in this case? 4. What are the diagnostic tests for H. pylori infection ? 5. What will be your action? Justify your answer 6. What are the referral points of peptic ulcer?  Case 6 A 68-year-old woman complains from epigastric abdominal pain, bloating, and nausea. She has a history of type 2 diabetes with peripheral neuropathy and hypertension. on questioning she reports no known drug allergies and takes metformin 1000 mg twice daily, aspirin 325 mg/day, lisinopril 20 mg once daily, and gabapentin 1000 mg three times daily. In addition, she reports using OTC ketoprofen daily for the past 2 months secondary to uncontrolled pain. Her endoscopy reveals a 1-cm gastric ulcer with an intact clot. A rapid urease test (CLO) performed on the ulcer biopsy specimen is negative.  Case 6 1. What do you think the patient is suffering from ?explain your answer 2. What will be your action? Justify your answer 3. What is the best treatment options for this patient?