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Mr. TJ, a 55-year old police officer, was diagnosed with a bleeding ulcer about a year ago whereby he was given multiple prescriptions for his stomach. However, he did not complete the course of therapy because he began feeling better. For the last two weeks, he has presented to the clinic with epigastric pain for two weeks and has been taking over-the-counter (OTC) Zantac without relief. Mr. TJ expresses concerns that the current symptoms with the bleeding ulcer he was diagnosed with about a year ago. Besides, he suffers from osteoarthritis in his hips and wrists which he takes OTC NSAIDs. He drinks an average of one alcoholic beverage daily and smokes one to two packs per week. His vital signs and blood work are within the normal limits. This paper seeks to explore the additional testing to be suggested at this point, variables contributing to his symptoms, and suggested alterations for his treatment.

Additional Testing to be suggested

Following Mr. TJ’s condition, I would suggest that the doctor to carry out an endoscopy which is an important test to detect the real cause of the pain in the epigastric area. Endoscopy is usually performed to access problems related to the stomach, intestines, and esophagus (Kay, 2012). The doctor should order an endoscopy to visually examine the organs in the epigastric region to determine the cause of pain. If the doctor suspects that a particular area or an organ of the patient is damaged infected, or cancerous, he or she will order a biopsy. The endoscopic biopsy will involve the use of forceps in the endoscope to obtain a small sample of the tissue. The endoscopy sample will be taken to the lab for testing. The lab results will help the doctor to gain a more accurate understanding of the possible cause of the pain in Mr. TJ’s condition.


Variables that could be Contributing to Mr. TJ’s Symptoms

Epigastric pain is associated with many disorders and diseases. Therefore, it becomes a challenge to diagnose the particular condition causing this pain. The possible etiologies behind Mr. TJ’s pain include peptic and duodenal ulcer, gastrointestinal reflux disease, and heartburn, diseases of the stomach, gastritis, gastric carcinoma, and gastroenteritis. Peptic and Duodenal ulcers are the most common of the epigastric pain. In this case, the ulcer results from infection by Helicobacter pylori bacteria. Gastric carcinoma is a malignancy of the stomach associated with pain in the upper central area of the abdomen. Gastritis is an internal inflammatory of the lining of the stomach and generates pain in the epigastric area. Diseases of the stomach can also cause epigastric pain. The most common disease is the peptic ulcer disease whereby pain arises from inflammatory conditions. Heartburns are associated with burning sensation as a result of excessive gastric secretions which causes pain behind the sternum and in the epigastric region while gastroenteritis is the inflammatory disease of the stomach and intestines and is associated with abdominal pain.

Suggested alterations for Mr. TJ’s Treatment

Treatment is administered depending on the diagnosis of pain in the epigastric region. Pain which occurs instantly and settles within a few hours does not require treatment as such. However, pain related to different other symptoms requires special treatment. Following Mr. TJ’s condition, I would suggest an alternative treatment by use of a Non-Steroidal Anti-inflammatory Drugs (NSAIDs) because these drugs are quite useful in relieving pain. For instance, Ibuprofen is helpful in treating pain. Besides, the suggested endoscopy diagnosis can be used to determine whether the problem can be treated without an endoscopy or surgery. Also, prophylaxis would be appropriate for NSAID-induced ulcers.

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