. Provide a bulleted list of your learning points from the clinical case you analyzed this week and the salient features of what you have envisioned for patient education in your care plan.

. Provide a bulleted list of your learning points from the clinical case you analyzed this week and the salient features of what you have envisioned for patient education in your care plan.

List key points about the patient’s presenting diagnoses, how you determined

these, what diagnostic tests you ordered to confirm your diagnoses, and, most importantly,

what you learned about patient education for gastrointestinal system based on your

research.
Week 3: Gastroenterology Clinical Case

HPI

A 60-year-old Italian male presents with acute abdominal pain. He is a retired

schoolteacher and still does some teaching on the side. He is complaining of acute onset of

umbilical pain that started last evening after eating. He is experiencing a gnawing hunger

pain in the umbilical area. The pain is more diffuse now and he feels nauseous, but there

is no vomiting. He believes he had fever last night because he felt very warm and sweaty.

His symptoms subsided after he sat up for a few hours on a chair, but he is not sure how it

went away.

The patient has been having these symptoms for the past 24 hours. He has had similar

symptoms in the past, but it was not as bad as this. The pace of illness was worse last

night and is much better now. In the past, the symptoms would last only an hour or two and

resolve spontaneously.

In terms of severity, the pain experienced last night, during the “attack,” was a ten.

Today, it is a seven. He was awake last night and the pain has been bothering him for the

past 24 hours. Last night, the pain was more localized in the periumbilical region. It is

more diffuse now. The pain does not radiate to the back; it is mainly generalized in the

abdomen now and less intense from what it was last night.

He has also been having some heartburn-like symptoms for the past two weeks. The symptoms

increased after eating. The heartburn would resolve spontaneously within a few hours and

sometimes it was relieved after he took some OTC antacids. The patient thinks he is having

a heart attack. The worsening of his symptoms has made him seek medical care today.

PMH

The patient is being treated for hypercholesterolemia, hypertension, and gout. He goes to

his primary care provider every three to four months for a routine checkup. The patient had

“stomach” problems as a young man but he is not sure of the diagnosis that was

back then, but nothing else. He had an appendectomy 20 years ago, without any

complications. He has been using a lot of non steroidal anti-inflammatory drugs (NSAIDs) to

control his gout symptoms. Besides these, the patient has had no significant illnesses.

The patient states that he has always had a “queasy stomach” and has had no other workups

to date for the problem. He knows that he has some type of heartburn problem, but is

treating it with only over-the-counter medications and has had no further investigations.

ROS

Intermittent heartburn symptoms for a few weeks, nausea. No vomiting. No blood in the

stool.

MEDICATIONS

Indocin 50 mg Q 6 hours PRN gout symptoms Zocor 20 mg QD
Propranolol 50mg BID

The patient is not compliant with the prescribed regimen because he is concerned about the

side effects of the medication. However, he seems to be over using Indocin as he has been

experiencing symptoms of gout for the past one month.

He is also trying alternative therapy such as, Saint John’s wort because he thinks he is

suffering from depression. He has been taking three capsules three times a day since last

month, but has not noted any difference in his symptoms.

ALLERGIES/REACTIONS

He has no known drug allergies.

SOCIAL HISTORY

He is a retired schoolteacher and still does some teaching on the side. He is living off a

state teachers’ pension. His wife continues to work in a local grocery store. They are

getting by but do not always have enough money to go traveling. He has a master’s degree in

education. Together, they make $50,000.00 per year. The patient has access to a primary

care provider and sees him three to four times per year. He has a health insurance coverage

including prescription cover.

His wife has osteoarthritis of both knees and hips. This limits her ability to be active.

The patient would like to be more active but he is having problems with gout recently. Both

husband and wife would like to be more active but don’t know if that will be possible,

considering the pain that they are in. They have two grown-up children—a son and a

daughter—living outside the home, both alive and well.

This patient is very concerned about his symptoms and wondering whether he is having a

heart attack, because his father died at the same age. His wife is equally concerned. The

patient feels that he has had a good life and does not want it to end early. He does not

have any undue stress and is hoping that something can be done to treat him. He feels that

the medical community should be able to cure him. He does not feel the need to change his

lifestyle to be healthier.

His support systems include his wife and some of the people that he used to work with, in

the school district. He still meets them occasionally. He is not suffering from social

isolation and would like to somehow become more involved in the community, because he

thinks it may help him cure his symptoms of depression.

Though the patient gets anxious very easily, he does not like to show it. He walks one or

two days per week. He knows he needs to do more, but his pain is a detriment. He likes to

go and meet his primary care provider, but sees it more as a social event.

HABITS

Smoking: Non-smoker
Alcohol: He drinks wine every night, sometimes to excess (4 to 5 glasses) Substance abuse:

Denies use of drugs

DIET HABITS
His wife tries to make a healthy meal at home, but he finds himself eating fast food


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