This File contains case studies about GIT disorders as Gerd and H.pylori and Peptic Ulcers

1. Case studies
“GIT disorders“
By : Joseph Adel

3. Patient profile
– 28 years old, female
– Weight: 87 Kg
– Height: 165 cm
– Non smoker

4. Physical Examination:
• B.P. 126/80
• Pulse : 92 bpm
No
conjunctival
pallor
Moderate
tenderness to
palpation in the
epigastrium,
no masses, no
palpable
organomegaly .
• Normal
thyroid

5. Symptoms
 Complains of intermittent pain in the upper abdomen, which has been
occurring over the last six months.
 Pain generally occurs two to three times per week after eating
 Pain is not associated with activity, body position, time of day or menstrual
cycle.
 Patient cannot describe any exacerbating or mitigating factors.
 Occasional nausea, but no vomiting or heartburn.
 No alteration in bowel habits, melena or hematochezia

6. Investigations
CBC :
Normal
Liver enzymes : Normal {ALT: 30 U/L , AST:20 U/L}
Renal Function:
• Normal {serum creatinine: 1mg/dl}
• Creatinine clearance: 100 ml/min
• BUN: 12 mg/dl
Red blood cells 4.5 trillion cells/L
Hemoglobin 13 grams/dl
Hematocrit 40%
White blood cells 5 billion cells/L
Platelet count 200 billion/L

7. History
• Medical History : Depression for 2 years
• Family History : Her father is diabetic

8. Rx
 Ethinyl estradiol
 Levonorgestrel x 3 years
 Citalopram 20 mg daily x 2 years

9. Discussion
Question 1:
Are any further investigations required at this
time ? ..

10. Question 2
What is your primary diagnosis for this patient?
a. GERD
b. Functional Dyspepsia
c. GIT bleeding
d. Peptic Ulcer

11. Question 3
• What is your recommended medication ?
a. H2 blocker
b. PPIs
c. Antacids
d. Prokinetics
e. Combination
f. Others
**Please justify your choice and specify the product used

12. Question 4
If this patient was suffering from
Type II diabetes,
Would you recommend any
changes to the current
medications ?! ..

13. (2)

14. Patient Profile
• 54 years old, female
• Body weight: 72 Kg
• Non smoker

15. Physical Examinations
• B.P. : 142/82
• Pulse : 76 bpm
• Respiration : 16
• Heart sounds are normal with clear lungs
• Abdomen is softly distended without succession
splash

16. Presentation
• HbA1c is 8%
• FPG is 175 mg/dl despite limiting sweet intake
• She was presented with GIT complaints of early satiety ,heartburn
and nausea that have been getting worse over the past 2-3
months despite eating small frequent meals with low fate
intake.

17. History
• Diagnosed with type II diabetes at the age of 43.
• She has borderline hypertension (controlled by diet and
exercise)
• Moderate arthritis
• She has a family history of CAD & colon cancer
• She lost 2 Kg in the past 8 months.

18. Current Medication
 Glimepride 3 mg qd
Ibuprofen 600 mg (when needed)
Temazapam 15 mg (when needed)
Antacids (to relief the heart burn)

19. Investigation
• Esophago-gastroduodenoscopy (EGD)
– Revealed mild antral erythema and food residue in her gastric cavity despite the
midnight fast.
– Biatal hernia was present with no signs of esophagitis or Barrette esophagus.
• H.pylori testing (biopsy)
– Negative

20. Discussion
• Question 1 :
What is your primary diagnosis for this patient?
a. GERD
b. Gastroparesis
c. Peptic Ulcer
d. Dyspepsia

21. Question 2
• What is your recommended medication to manage her GIT
complaints ?
a. PPIs (Omeprazole,Esomeprazole,Pantoprazole,Lanzoprazole or
Rabeprazole)
b. H2 blockers (Ranitidine,Famotidine,Nizatidine)
c. Antacids
d. Prokinetics (Metoclopromide,Domperidone,Mosapride or Itopride)
e. Combination
f. None of the above
**Please justify your answer in question 2 and specify the product selected.

22. Question 3
• Do you recommend any changes to her current
diabetes medication ??
**If your answer is Yes, Please specify.