Gastrointestinal and Hepatobiliary Disorders

QUESTION 1

1. A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that has persisted for 2 weeks. He describes the pain as burning, non-radiating and is worse after meals. He denies nausea, vomiting, weight loss or obvious bleeding. He admits to bloating and frequent belching.

PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.

Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain

Family Hx-non contributary

Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He 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.

1 of 2 Questions:

What factors may have contributed to the development of PUD? 

QUESTION 2

1. A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that has persisted for 2 weeks. He describes the pain as burning, non-radiating and is worse after meals. He denies nausea, vomiting, weight loss or obvious bleeding. He admits to bloating and frequent belching.

PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.

Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain

Family Hx-non contributary

Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He 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.

2 of 2 Questions:

How do these factors contribute to the formation of peptic ulcers? 

QUESTION 3

1. A 36-year-old morbidly obese female comes to the office with a chief complaint 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.

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

Family history-non contributary

Medications-amlodipine 10 mg po qd, dicyclomine 20 mg po, ibuprofen 600 mg po q 6 hr prn

Social hx- 15 pack/year history of smoking, occasional alcohol use, denies vaping

The health care provider diagnoses the patient with gastroesophageal reflux disease (GERD).

Question:

The client asks the APRN what causes GERD. What is the APRN’s best response? 

QUESTION 4

1. A 34-year-old constructionworker presents to his Primary Care Provider (PCP) with a chief complaint of passing foul smelling 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:

What factors can contribute to an upper GI bleed?