List three differential diagnoses for epigastric pain in adults. Include rationale, diagnostic testing, and treatment.
Epigastric is the pain that comes on the upper middle portion of the abdomen. It this can occur due to several conditions i.e. irritable bowel syndrome, peptic ulcer, and pancreatitis, and as a referred pain of myocardial infarction among other minors ones. Diagnosis and treatment
Peptic ulcer disease
Peptic ulcer disease (PUD) is erosion of the gastrointestinal mucosa, usually in the stomach (gastric ulcer) or duodenum (duodenal ulcer). It is caused by excess secretion of hydrochloric acid or decreased mucosal resistance, PUD affects both men and women. Typically …show more content…
The exposure to reflux material can be enhanced when the normal lower esophageal sphincter (LES) pressure is altered by drugs, diaphragmatic ligaments (hiatal hernia), and abdominal pressure (pregnancy and obesity). Normally, swallowing initiates peristalsis that results in relaxation of the LES. When GERD is present, the LES relaxes independently of peristalsis, and this transient relaxation removes the LES barrier to reflux. The symptoms presents as heartburn, epigastric pain, retrosternal burning, acid regurgitation, hoarseness, and dysphagia. Diagnosis for GERD is usually is through the history and chief complaints as there is no standard testing. EGD is the standard for assessing esophageal complication it lacks sensitivity for identifying pathologic reflux, but it helps to rule out associated complications with the presence of GERD such as esophagitis and Barrett esophagus. Treatment for GERD is focused towards lifestyle modification coupled with pharmacologic control of gastric acid secretion. Two pharmacologic approaches are used in GERD is the step-up therapy which is prescription for histamine-2 receptor antagonists (H2Ras) and titrate to symptom control. The other is the step-down therapy which indicates once or twice daily proton pump …show more content…
Acute pancreatitis is pancreatic inflammation due to auto-digestion. The condition that develops when injury to the pancreatic duct allows proteolytic pancreatic enzymes to be activated prematurely in pancreatic tissue. The inflammatory response this initiates produces varying degrees of pancreatic edema, fat necrosis and hemorrhage. Acute Pancreatitis symptoms is a continuous, boring, epigastric pain, sometimes mistaken for an orthopedic pain. It often occurs between 24 and 48 hours after the ingestion of a heavy, fatty meal or the heavy use of alcohol as acute pain and radiates to the back area and comes with vomiting. The pain is relieved by siting forward. Abdominal tenderness is likely to be worst in the epigastrium. A bluish discoloration in the loins, known as the Grey-Turner 's sign is not seen immediately but develops a few days after hypovolemia and so is not a diagnostic tool in early presentation. Diagnoses Acute pancreatitis is confirmed by medical history, physical examination, and typically a blood test (amylase or lipase) for digestive enzymes of the pancreas. Blood amylase or lipase levels are typically elevated 3 times the
Epigastric is the pain that comes on the upper middle portion of the abdomen. It this can occur due to several conditions i.e. irritable bowel syndrome, peptic ulcer, and pancreatitis, and as a referred pain of myocardial infarction among other minors ones. Diagnosis and treatment
Peptic ulcer disease
Peptic ulcer disease (PUD) is erosion of the gastrointestinal mucosa, usually in the stomach (gastric ulcer) or duodenum (duodenal ulcer). It is caused by excess secretion of hydrochloric acid or decreased mucosal resistance, PUD affects both men and women. Typically …show more content…
The exposure to reflux material can be enhanced when the normal lower esophageal sphincter (LES) pressure is altered by drugs, diaphragmatic ligaments (hiatal hernia), and abdominal pressure (pregnancy and obesity). Normally, swallowing initiates peristalsis that results in relaxation of the LES. When GERD is present, the LES relaxes independently of peristalsis, and this transient relaxation removes the LES barrier to reflux. The symptoms presents as heartburn, epigastric pain, retrosternal burning, acid regurgitation, hoarseness, and dysphagia. Diagnosis for GERD is usually is through the history and chief complaints as there is no standard testing. EGD is the standard for assessing esophageal complication it lacks sensitivity for identifying pathologic reflux, but it helps to rule out associated complications with the presence of GERD such as esophagitis and Barrett esophagus. Treatment for GERD is focused towards lifestyle modification coupled with pharmacologic control of gastric acid secretion. Two pharmacologic approaches are used in GERD is the step-up therapy which is prescription for histamine-2 receptor antagonists (H2Ras) and titrate to symptom control. The other is the step-down therapy which indicates once or twice daily proton pump …show more content…
Acute pancreatitis is pancreatic inflammation due to auto-digestion. The condition that develops when injury to the pancreatic duct allows proteolytic pancreatic enzymes to be activated prematurely in pancreatic tissue. The inflammatory response this initiates produces varying degrees of pancreatic edema, fat necrosis and hemorrhage. Acute Pancreatitis symptoms is a continuous, boring, epigastric pain, sometimes mistaken for an orthopedic pain. It often occurs between 24 and 48 hours after the ingestion of a heavy, fatty meal or the heavy use of alcohol as acute pain and radiates to the back area and comes with vomiting. The pain is relieved by siting forward. Abdominal tenderness is likely to be worst in the epigastrium. A bluish discoloration in the loins, known as the Grey-Turner 's sign is not seen immediately but develops a few days after hypovolemia and so is not a diagnostic tool in early presentation. Diagnoses Acute pancreatitis is confirmed by medical history, physical examination, and typically a blood test (amylase or lipase) for digestive enzymes of the pancreas. Blood amylase or lipase levels are typically elevated 3 times the