Introduction
A 26-year-old graduate student presents with a 3–4 month history of gnawing upper-middle abdominal pain that improves in the morning, worsens throughout the day, and is partially relieved by antacids. Her symptoms are sometimes accompanied by severe diarrhea, fatigue, weakness, and nausea, and she reports high stress related to her Ph.D. defense, increased smoking, heavy coffee consumption, and regular evening alcohol use.
The patient needs to manage her health and well-being effectively, especially considering her gnawing pains in the upper-middle abdomen, along with weakness, nausea, and weariness. Based on her complaints, lifestyle choices, and medication usage, several conditions could potentially be causing her symptoms, with peptic ulcer disease (PUD) being a possible diagnosis that matches her clinical presentation. Smoking can decrease the production of protective mucus and affect blood flow to the stomach lining, increasing the risk of PUD. Excessive consumption of coffee and alcohol can also contribute to ulcer development by irritating the stomach lining and stimulating gastric acid production. Considering her lifestyle choices and medication usage, PPIs may be more effective for managing her symptoms than OTC antacids. To better manage her problems, it is essential to make certain lifestyle modifications.
Possible Diagnosis
Upper-middle abdomen discomfort and other symptoms, including weakness, nausea, and exhaustion, are all possible consequences of peptic ulcer disease (PUD). Elements including H. pylori infection, smoking, excessive coffee use, and alcohol usage can bring on PUD. Gastritis, an inflammation of the stomach lining, can cause upper-middle abdominal discomfort and several related symptoms. Nonsteroidal anti-inflammatory medication (NSAID) is used for an extended period. H. pylori infection, excessive alcohol intake, and stress are some of the causes. (Vano et al., 2020).
Gastroesophageal Reflux Disease (GERD). This condition occurs when the stomach acid flows back into the esophagus, leading to upper-middle abdominal pain, heartburn, and nausea. Risk factors for GERD include obesity, smoking, certain foods, and certain medications. Problems with the gallbladder, such as gallstones or inflammation (cholecystitis), can cause upper-middle abdominal pain that may radiate to the back.
These conditions can also lead to symptoms like fatigue, weakness, and nausea. Inflammation of the pancreas, known as pancreatitis, can cause upper-middle abdominal pain that may be severe and radiate to the back. Other symptoms can include fatigue, weakness, and nausea. Risk factors for pancreatitis include excessive alcohol consumption, gallstones, and certain medications.
Possible Diagnostic Tests and Potential Diagnoses
The doctor may prescribe the following diagnostic tests to assess the patient further and investigate potential diagnoses based on their symptoms, history, and relevant risk factors. The doctor can use an endoscope to examine the esophagus, stomach, and duodenum up close. The patient’s symptoms of gnawing pains in the upper-middle abdomen can assist in determining the presence of peptic ulcers. In addition, the endoscope can identify further disorders, including esophagitis or gastritis, which are both esophageal inflammations.
The doctor may request testing to screen for the presence of H. pylori, given the likelihood that this infection may cause peptic ulcers. H. pylori can be found with a breath test, which involves the patient drinking a solution and exhaling it into a specific bag (Bordin et al., 2021). To determine H. pylori infection, a blood antibody test or a stool antigen test might be utilized.
The patient’s blood cell counts may be learned from a complete blood count (CBC). Low amounts of hemoglobin and red blood cells may be signs of anemia, which may be detected with the aid of this test. Iron deficiency anemia, which may be brought on by persistent blood loss from a peptic ulcer, may add to the patient’s fatigue and weakness.
An examination of the patient’s face may be necessary to check for any potential infectious reasons, given the patient’s complaint of severe diarrhea. The study can find any pathogens, such as viruses, bacteria, or parasites, that may be causing diarrhea. Imaging tests could be taken into consideration if the doctor has a suspicion that one or more problems exist. A thorough image of the abdominal organs may be obtained with an abdominal ultrasound, which can also assist in spotting any structural irregularities.
A CT scan or MRI may be prescribed to examine the belly further and rule out illnesses like gallstones or pancreatitis, which can cause upper abdominal discomfort and other symptoms. The doctor may also request liver function tests in light of the patient’s stated alcohol intake and the potential involvement of the liver. These tests can measure liver enzymes and other indicators of liver function, revealing details about the liver’s condition and operation.
Doctors explore possible diagnoses based on the patient’s symptoms, lifestyle choices, and diagnostic options. The disease of the stomach (PUD) is compatible with the patient’s complaints of gnawing upper-middle abdomen discomfort that worsens during the day and is relieved by antacids. Peptic ulcer disease can be exacerbated by lifestyle choices such as excessive coffee intake, smoking, and stress. GERD may be the cause of the patient’s symptoms, which include upper-middle abdomen pain that gets worse over the day. Due to increased stomach acid production and a relaxed lower esophageal sphincter, stress, smoking, and coffee use might worsen GERD symptoms.
Irritable bowel syndrome (IBS) may be indicated by the presence of severe diarrhea, in addition to stomach discomfort and the patient’s overall symptom pattern. IBS symptoms can be significantly triggered by stress, and the patient’s stated stress level may play a role in the onset or exacerbation of symptoms (Zhao et al., 2019). The doctor could think that gastroenteritis is the cause of extreme diarrhea and other symptoms. The stool analysis can assist in locating the exact pathogen causing the symptoms if an infectious etiology is suspected.
Class of Medications that Might be Better
For this patient, different drugs may be explored in addition to over-the-counter (OTC) antacids like Mylanta or Milk of Magnesia to treat her upper-middle abdomen discomfort symptoms and related problems. Proton pump inhibitors (PPIs) are a class of drugs that may be a better option for this patient. PPIs are a class of medications that lower the production of stomach acid and offer longer-lasting and more potent symptom relief than antacids.
PPIs work by blocking the enzyme in the stomach that produces acid, lowering the acidity and promoting ulcer healing. Patients with gastroesophageal reflux disease (GERD) or peptic ulcer disease (PUD) benefit the most from PPIs. They can aid in reducing acid reflux symptoms, such as heartburn, and peptic ulcer repair.
For this patient, PPI usage may be more beneficial. PPIs alleviate symptoms longer than antacids because they consistently inhibit stomach acid output. It has been demonstrated that PPIs are more helpful than antacids in promoting peptic ulcer repair. They aid in lowering the acidic environment in the stomach, promoting optimal ulcer healing. PPIs can better treat the symptoms of illnesses like GERD by decreasing the formation of stomach acid and lowering regurgitation and related symptoms like heartburn. PPIs aid patients with illnesses like GERD and peptic ulcers by regulating the total acid production in the stomach.
Type of Teaching
The patient should research stress-reduction methods such as deep breathing exercises, meditation, frequent exercise, and partaking in leisure activities. The doctor should encourage the patient to stop smoking since doing so can worsen their symptoms and make their peptic ulcers take longer to heal. The patient should limit coffee and alcohol intake because they might increase acid production and worsen symptoms.
The patient is to identify and avoid foods that make her symptoms worse. Spicy food, acidic food, fatty food, and caffeine are examples of common triggers. Instead of consuming large meals simultaneously, the patient must spread their meals throughout the day. This can assist in limiting the formation of stomach acid and relieving symptoms.
The doctor must inform the patient of how PPIs can help to cure ulcers by lowering stomach acid production, the significance of adhering to a doctor’s regular follow-up schedule, and the necessity of taking PPIs as directed. The doctor must also explain to the patient the possible adverse effects of PPIs and the significance of sharing any worries or unpleasant reactions with her doctor. The patient should be aware of the value of regular follow-up appointments with her doctor to track progress, evaluate the efficacy of the treatment plan, and make any required modifications.
Conclusion
Considering the patient’s symptoms, lifestyle habits, and medication history, peptic ulcer disease (PUD) appears to be a likely diagnosis consistent with the clinical findings. Lifestyle modifications are crucial for managing the symptoms effectively. The patient should consider quitting smoking, limiting coffee and alcohol intake, and adopting stress-reduction methods.
Proton pump inhibitors (PPIs) may be more effective than over-the-counter antacids for managing the symptoms and promoting ulcer healing. The patient should adhere to a balanced diet, spread out meals throughout the day, and avoid foods that trigger symptoms. Regular follow-up appointments with the doctor are essential to track progress and make any necessary adjustments to the treatment plan. Awareness of gastrointestinal bleeding symptoms and seeking immediate medical attention if they occur is essential. Additionally, seeking support for managing stress and maintaining emotional well-being can be beneficial during this challenging time.
References
Bordin, D. S., Voynovan, I. N., Andreev, D. N., & Maev, I. V. (2021). Current Helicobacter pylori diagnostics. Diagnostics, 11(8), 1458. Web.
Kuna, L., Jakab, J., Smolic, R., Raguz-Lucic, N., Vcev, A., & Smolic, M. (2019). Peptic ulcer disease: a brief review of conventional therapy and herbal treatment options. Journal of clinical medicine, 8(2), 179. Web.
Vano, L., Varma, S., & O’Donohue, J. (2020). Gastro‐oesophageal Reflux and Peptic Ulcer Disease. The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry, 171.
Zhao, D. Y., Qi, Q. Q., Long, X., Li, X., Chen, F. X., Yu, Y. B., & Zuo, X. L. (2019). Ultrastructure of intestinal mucosa in diarrhea-predominant irritable bowel syndrome. Physiology International, 106(3), 225-235. Web.