TJ is a fifty-five-year-old police officer who presents to the clinic with complaints of epigastric pain for two weeks. He has been taking over-the-counter (OTC) Zantac without relief. He was diagnosed about a year ago with a bleeding ulcer, and he expresses concerns that the current symptoms remind him of that event. At that time, he was given “multiple prescriptions” for his stomach, but he did not complete the course of therapy because he began to feel better. He also has osteoarthritis in his wrists and hips, for which he takes OTC NSAIDs. He smokes one to two packs per week and drinks an average of one alcoholic beverage daily. His vital signs and blood work are all within normal limits. Answer the following questions; As headers of your paper, please remember to cite your source.
- What additional testing would you suggest at this point?
- Describe any and all variables that could be contributing to his symptoms.
- What alterations would you suggest in his treatment? Be sure to consider additional diagnoses and whether prophylaxis would be appropriate for NSAID-induced ulcers.
Support your responses with the guidelines you locate in the literature and peer-reviewed articles as needed to support your ideas.
Expert Solution Preview
Introduction:
The case of TJ, a fifty-five-year-old police officer with a history of bleeding ulcer, presents a challenge in terms of identifying the cause of his current epigastric pain and recommending a suitable treatment plan. As a medical professor, it is important to evaluate TJ’s medical history and identify any potential variables that could be contributing to his symptoms. In addition, a thorough assessment of his current medications, lifestyle factors, and additional testing options can help in devising an effective treatment strategy while minimizing the risk of side effects or complications. Therefore, this paper aims to answer the following questions.
1. What additional testing would you suggest at this point?
Based on TJ’s medical history and current symptoms, additional testing options that can be considered include endoscopy, abdominal ultrasound, and stool test for occult blood. Endoscopy can help in visualizing the extent of the ulcer and identifying any complications such as bleeding or perforation. Abdominal ultrasound can detect any abnormalities in the liver, pancreas, or gallbladder, which may also contribute to epigastric pain. Stool test for occult blood can help identify any bleeding in the digestive tract, which can be indicative of an active ulcer.
2. Describe any and all variables that could be contributing to his symptoms.
Several variables can contribute to TJ’s symptoms, including his history of bleeding ulcer, use of OTC NSAIDs, smoking, and alcohol consumption. NSAIDs can irritate the gastric mucosa and increase the risk of gastric ulcers, especially in individuals with a history of peptic ulcer disease. Smoking can also increase the risk of peptic ulcer disease and delay healing of existing ulcers. Alcohol can irritate the stomach lining and increase acid secretion, which can exacerbate existing ulcers.
3. What alterations would you suggest in his treatment? Be sure to consider additional diagnoses and whether prophylaxis would be appropriate for NSAID-induced ulcers.
Based on TJ’s medical history and current symptoms, alterations in his treatment can include discontinuation or reduction of NSAID use, use of proton-pump inhibitors for acid suppression, and initiation of H. pylori eradication therapy if infection is detected. Prophylaxis for NSAID-induced ulcers can be considered for individuals with a history of peptic ulcer disease or those requiring long-term NSAID use. Smoking cessation and reduction of alcohol consumption can also help in reducing the risk of ulcer formation and recurrence.
Sources:
1. Lanza FL, Chan FK, Quigley EM, Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009 Mar;104(3):728-38.
2. Tariq SH, Graham DY. Peptic ulcer disease. Am Fam Physician. 2018 Aug 1;98(3):129-36.
3. Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007 Aug;102(8):1808-25.
