Gastrointestinal and Hepatobiliary Disorders

Scenario 1: Peptic Ulcer

A 65-year-old female comes to the clinic with a complaint of
abdominal pain in the epigastric area. The pain has been persistent for two
weeks.  The pain described as burning, non-radiating and worse after
meals. Denies N&V, weight loss or obvious bleeding. She admits to frequent
belching with bloating.  

PMH:  seasonal allergies with Chronic Sinusitis, positive for
osteoarthritis, 

Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain 

Family Hx-non contributary  

Social history: Separated recently pending divorce; stressful
situation with trying to manage two homes. Works as a Legal Assistant at a
local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day,
and 6-7 cups of coffee per day. She denies illicit drug use, vaping or unprotected
sexual encounters.  

Breath test in the office revealed + urease. 

The healthcare provider suspects the client has peptic ulcer
disease.

Questions:

1.     Explain what contributed to the
development from this patient’s history of PUD?

Scenario 2: Peptic Ulcer

A 65-year-old female comes to the clinic with a complaint of
abdominal pain in the epigastric area. The pain has been persistent for two
weeks.  The pain described as burning, non-radiating and worse after
meals. Denies N&V, weight loss or obvious bleeding. She admits to frequent
belching with bloating.  

PMH:  seasonal allergies with Chronic Sinusitis, positive for
osteoarthritis, 

Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn
pain 

Family Hx-non contributary  

Social history: Separated recently pending divorce; stressful
situation with trying to manage two homes. Works as a Legal Assistant at a
local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day,
and 6-7 cups of coffee per day. She denies illicit drug use, vaping or unprotected
sexual encounters.  

Breath test in the office revealed + urease. 

The healthcare provider suspects the client has peptic ulcer
disease.

Question:

1.    What is the pathophysiology of PUD/ formation of peptic
ulcers? 

Scenario 3: Gastroesophageal Reflux Disease (GERD)

A 44-year-old morbidly obese female comes to the clinic
complaining of “burning in my chest and a funny taste in my mouth”. The
symptoms have been present for years but patient states she had been treating
the symptoms with antacid tablets which helped until the last 4 or 5
weeks. She never saw a healthcare provider for that. She says the
symptoms get worse at night when she is lying down and has had to sleep with 2
pillows. She says she has started coughing at night which has been interfering with
her sleep. She denies palpitations, shortness of breath, or nausea. 

Past Medical History -HTN, venous stasis ulcers, irritable bowel
syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2) 

Family History: non contributary   

Medications: Lisinopril 10 mg po qd, Bentyl 10 mg po, ibuprofen
800 mg po q 6 hr prn 

Social History: 20 PPY of smoking, ETOH rarely, denies vaping    

Diagnoses: Gastroesophageal reflux disease (GERD). 

Question:

1.     If the client asks what causes GERD how would you explain this as
a provider? 

Scenario 4: Upper GI Bleed

A 64-year-old male presents the clinic with complaints
of passing dark, tarry, stools. He stated the first episode occurred
last week, but it was only a small amount after he had eaten a dinner
of beets and beef. The episode today was accompanied by nausea, sweating, and
weakness. He states he has had some mid epigastric pain for several weeks and
has been taking OTC antacids. The most likely diagnosis is upper GI bleed which
won’t be confirmed until further endoscopic procedures are performed.

Question:

1.   
What
are the variables here that contribute to an upper GI bleed? 

Scenario 4: Diverticulitis

A 54-year-old schoolteacher is seeing your today for
complaints of passing bright red blood when she had a bowel movement this
morning. She stated the first episode occurred last week. The episode today was
accompanied by nausea, sweating, and weakness. She states she has had
some LLQ pain for several weeks but described it as “coming and
going”. She says she has had a fever and abdominal cramps that have
worsened this morning.

Diagnosis is lower GI bleed secondary to diverticulitis.

Question:

1.     What can cause diverticulitis in the lower GI tract?