A26-year-old woman in graduate school visits the family physicianbecause for the past 3–4 months she has been experiencing gnawingpains in her upper-middle abdomen. When you ask her what seems toprecipitate the pain, she is unable to say for sure. She says shefeels the best in the early morning before eating. As the dayprogresses, she usually feels worse and takes Mylanta or Milk ofMagnesia to relieve the pain. Sometimes, her pain is accompanied bysevere diarrhea, and she has been tired, weak, and nauseous. Inresponse to your question about stress, she tells you she is underextreme stress because she is preparing to defend her thesis forher Ph.D. She has been smoking more cigarettes than usual anddrinking 6–8 cups of coffee each morning. In the evening, she oftenhas a few glasses of wine to help her relax.
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Based onthis patient’s complaints, lifestyle, and use of OTC medications,what do you expect may be the cause of her initial complaint ofupper-middle abdomen pain and her symptoms of fatigue, weakness,and nausea?
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Whatdiagnostic tests do you anticipate the physician ordering and forwhat possible diagnoses?
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Insteadof OTC antacids, what are the other choices for this patient torelieve her symptoms? Is there a class of medications you thinkmight be the better choice for her? If so, what and why?
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Whattype of teaching would you give the patient to better manage herproblems?
