60 yr old M presented with 3 days history of epigastric pain.
3 days ago while he was watching TV, he developed severe abdominal. He said it was so severe that he almost called the ambulance. The pain was described as sharp and lasted for few hours. He still has some epigastric pain today but it is mild. He also complained of nausea and loss of appetite. He drinks 6-8 beers per day. In the last few days, he didn't drink more than what he normally would drink. There was no vomiting, diarrhoea, recent travelling or malaena.
On examination, his vitals were stable. Abdominal exam: tender epigastric region. PR: no malaena.
What do you think is going on? How would you manage this patient ?
My differential diagnoses were: peptic ulcer disease, pancreatitis, cholecystitis. Diagnoses that I didn't want to miss: MI and AAA.
I ended up ordering FBE, UEC, LFT, CRP and Lipase and started him on a PPI. I plan to refer him to a surgeon when he returns for the blood test results. I also try to advice him to cut down on his ETOH but I doubt he listened to me.
I will update the post once he comes back for his blood test results.
In addition, this case brought me to the attention of long term safety of PPI. According to eTG:
- PPI is safe long term, however, lack of data for the use > 20 years
- May increase risk of CAP, travellers' gastroenteritis and hospital and community acquired C. diff.
- Initial concern of increasing incident of enterochromaffin tumour has not been confirmed.
End
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