Use APA 7th Edition Format and support your work with at least 3 peer-reviewed references within 5 years of publication. Remember that you need a cover page and a reference page. All paragraphs need to be cited properly. All responses must be in a narrative format and each paragraph must have at least 4 sentences. Lastly, you must have at least 2 pages of content, no greater than 4 pages, excluding cover page and reference page. Patient With Sudden Onset of Intermittent Mid-Epigastric Pain PR is a 35-year-old female who presents with a sudden onset of intermittent mid-epigastric pain that started 4 weeks ago. Pain is 6/10 on the pain scale and described as burning that worsens after she eats Mexican food and when she is lying down. She has never experienced this before. PR reports that she has been taking over the counter (OTC) antacids that seemed to help at first, but now they provide no relief. She reports associated regurgitation and feeling of fullness all the time and this morning she had a sore throat. Past Medical History • Anaphylactic reaction to penicillin Medications • OTC antacids Family History • Noncontributory Social History • Occupation: Elementary school teacher (10 years) • Nonsmoker • Denies illicit drug use • Consumes wine two to three times per month • Regular exercise Physical Examination • Weight: 145 lbs.; blood pressure: 128/72; pulse: 80; respiration rate: 18; temperature: 98.7 °F • General: Calm, cooperative, in no apparent distress • Eyes: Pupils equal, round, reactive to light • Ears: Tympanic membranes clear • Nares: Without nasal septal deviation; pharyngeal mucosa pink and moist • Throat: Oropharynx without edema, erythema, tonsillar enlargement, lesions • Abdomen: Nondistended, soft, round, nontender; normoactive bowel sounds in all quadrants Discussion Questions 1. What are the top three differential diagnoses for PR? 2. What diagnostic tests, if any, are required for PR? 3. What pharmacological, nonpharmacological, and/or nutraceutical therapies should be prescribed for PR?

Patient PR presents with a sudden onset of intermittent mid-epigastric pain that has been occurring for the past 4 weeks. The pain is described as burning and has a severity of 6/10 on the pain scale. PR reports that the pain worsens after eating Mexican food and when lying down. This pain is a new experience for PR, who has been taking over the counter (OTC) antacids that initially provided relief but are no longer effective. PR also reports associated symptoms of regurgitation, feeling of fullness, and a recent sore throat.

Based on the patient’s presentation, the top three differential diagnoses for PR’s symptoms could include gastroesophageal reflux disease (GERD), peptic ulcer disease, and gastritis.

GERD is characterized by the backward flow of stomach acid into the esophagus, resulting in symptoms such as heartburn, regurgitation, and chest pain. The burning pain that worsens after eating and lying down, as well as the associated symptoms of regurgitation and feeling of fullness, are consistent with GERD (Rubenstein & Chen, 2019).

Peptic ulcer disease (PUD) is marked by the presence of ulcers on the lining of the stomach or duodenum. Symptoms can include abdominal pain, which may be described as burning or gnawing, and may be relieved or worsened by eating. The intermittent nature of the pain and the fact that it worsens after eating could be indicative of PUD (Lanas & Chan, 2017).

Gastritis refers to inflammation of the stomach lining and can be caused by various factors including infection, medications, or autoimmune conditions. The burning pain and associated symptoms reported by PR are consistent with gastritis, as these symptoms often result from inflammation in the stomach (Kusters, van Vliet, & Kuipers, 2006).

To accurately diagnose PR’s condition, certain diagnostic tests may be needed. These could include an upper gastrointestinal (GI) endoscopy, which allows for direct visualization of the esophagus, stomach, and duodenum to identify any abnormalities or signs of inflammation. Additionally, a biopsy of the stomach lining may be performed during the endoscopy to check for the presence of H. pylori infection, a common cause of gastritis and PUD (Laine et al., 2017). Other diagnostic tests that could be considered include a barium swallow or pH monitoring to assess acid reflux into the esophagus.

As for the treatment of PR’s condition, it would depend on the specific diagnosis. If GERD is confirmed, pharmacological therapy could include proton pump inhibitors (PPIs) such as omeprazole, which reduce gastric acid production and help alleviate symptoms (Rao et al., 2019). Nonpharmacological measures for managing GERD could include lifestyle modifications such as avoiding trigger foods, elevating the head of the bed, and losing weight if necessary (El-Serag & Kahrilas, 2020).

In the case of peptic ulcer disease, treatment would involve a combination of medications to reduce acid production and eradicate H. pylori infection, if present. Proton pump inhibitors and antibiotics such as amoxicillin and clarithromycin are commonly used in this context (Malfertheiner et al., 2017). Nonpharmacological measures such as stress reduction and smoking cessation may also be recommended to aid in the healing process and prevent ulcer recurrence.

If gastritis is the confirmed diagnosis, treatment may involve the use of gastric acid suppressants such as PPIs or histamine-2 (H2) receptor blockers like ranitidine to reduce acid production and promote the healing of the stomach lining (Chey et al., 2017). Avoidance of irritants such as NSAIDs and alcohol, as well as dietary modifications, may also be recommended to manage symptoms and support healing.

In conclusion, the top three differential diagnoses for PR’s symptoms are GERD, peptic ulcer disease, and gastritis. To confirm the diagnosis, diagnostic tests such as upper GI endoscopy may be required. The treatment approach will depend on the specific diagnosis, with options including pharmacological, nonpharmacological, and/or nutraceutical therapies. Proper identification and management of PR’s condition will help alleviate her symptoms and improve her overall quality of life.


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