GI Differencial Diagnosis Help

[Ammie]

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Could you help me with ideas for what this patient has? Our consultant asked us to take her History and come up with a few options.

19 year old, female patient. Obese.

Presenting Complaint:
"Heart burn" felt daily for the past 2 weeks. Including waking up at night with heart burn.

History of Presenting complaint:
-Started 2 weeks ago
-Wakes up about 3 times a week with heart burn.
-No change in frequency of opening bowels
-Increased Flatus.
-Infrequent L sided loin region abdominal pain, sometimes increases/occurs when trying to pass stools
-Pain is not constant.
-Does not seem to get better after meals. Acid reflux and increased flatus tends to occur after meals.
-Pt had 1 episode of exploding diarrhea (which was described as "chocolate porridge" consistency)
-Generally feels better after passing stools but sometimes patient feels as if she has not completely emptied bowels.

Drug History:
Maalox Plus: Magnesium Hydroxide - Aluminum Hydroxide - Simethicone

Family History:
Mother: HT
Father: Duodenal Ulcer

Social History:
Lives at home with parents
non smoker
no alcohol

Allergies
Noprilam (but not Augmentin)


--------------------------------------

I am thinking maybe
An Ulcer
Irritable Bowel syndrome

Anything else?
Anyone agrees with the above 2 options?

 

[myhandsarecold]

GERD
too much acidic foods, caffeine
Achalasia
Biliary colic
Nonulcer dyspepsia
Peptic ulcer disease
Maltoma
Gastrinoma
regurgitation
hiatal hernia


she needs a PPI

 

[Ammie]

Give PPI for 2 weeks and then check up on patient again?

Also would the PPIs be needed lifelong if they work?

 

[Depakote]

Constipation

 

[Jolie South]

Give PPI for 2 weeks and then check up on patient again?

Also would the PPIs be needed lifelong if they work?

Maybe not? Heal the reflux damage with a long enough course to cure possible peptic ulcer/ erosive gastritis (in case that's what it is) and do lifestyle changes (not eating at nighttime, reducing spicy foods, etc) to keep it from coming back?

Possible dietary issue? She might be eating lots of foods that make her feel gassy (i.e. vegetables, white bread, milk).

 

[myhandsarecold]

Give PPI for 2 weeks and then check up on patient again?

Also would the PPIs be needed lifelong if they work?

probably not, if symptoms persist, consider an upper GI endoscopy, barium swallow studies, also be aware of Barrett's

she needs to loose weight too, big gut can push on her stomach causing regurge; not only that, she's at risk for diabetes and diabetic gastroparesis which can cause lifelong GERD

 

[Dral]

Think about the ABC's also. I doubt if cancer is too high in the differential though. Are we to assume she has no Surg. Hx?

 

[RiceOwl04]

When was her last period? Although it probably shouldn't be at the top of your differential in this case, you may want to include pregnancy somewhere below GERD and IBS, and probably above gastrinoma/maltoma given her age.

 

[Rendar5]

since this is allopathic and likely MS1/2, you're expected to get a hugely broad differential that you should not actually be using in real life.

so
IBS, IBD, Dyspepsia, GERD and more specific causes of itt (e.g hiatal hernia), Gastritis, PUD, all causes of PUD (aside from NSAIDS/HPylori) including Gastric Ca and Zollinger-Ellison. Stuff much lower down include endometriosis, partial SBO, parasitic infections. As this is very early on, I'm not going to go into management or treatment.

 

[richse]

GERD
too much acidic foods, caffeine
Achalasia
Biliary colic
Nonulcer dyspepsia
Peptic ulcer disease
Maltoma
Gastrinoma
regurgitation
hiatal hernia


she needs a PPI

How could this be achalasia? I didn't see any mention of trouble swallowing or vomiting.

 

[unsung]

Could you help me with ideas for what this patient has? Our consultant asked us to take her History and come up with a few options.

19 year old, female patient. Obese.

Presenting Complaint:
"Heart burn" felt daily for the past 2 weeks. Including waking up at night with heart burn.

History of Presenting complaint:
-Started 2 weeks ago
-Wakes up about 3 times a week with heart burn.
-No change in frequency of opening bowels
-Increased Flatus.
-Infrequent L sided loin region abdominal pain, sometimes increases/occurs when trying to pass stools
-Pain is not constant.
-Does not seem to get better after meals. Acid reflux and increased flatus tends to occur after meals.
-Pt had 1 episode of exploding diarrhea (which was described as "chocolate porridge" consistency)
-Generally feels better after passing stools but sometimes patient feels as if she has not completely emptied bowels.

Drug History:
Maalox Plus: Magnesium Hydroxide - Aluminum Hydroxide - Simethicone

Family History:
Mother: HT
Father: Duodenal Ulcer

Social History:
Lives at home with parents
non smoker
no alcohol

Allergies
Noprilam (but not Augmentin)


--------------------------------------

I am thinking maybe
An Ulcer
Irritable Bowel syndrome

Anything else?
Anyone agrees with the above 2 options?

Not trying to be a jerk, but is it appropriate to be posting this info?

 

[Rendar5]

Not trying to be a jerk, but is it appropriate to be posting this info?

why would it be? I see absolutely no identifiable information on the patient, nor is there identifiable information on the hospital, the poster, or the attending.