Question

A 40-year-old man presents with a 2-year history of severe, burning epigastric pain. A detailed history reveals that the pain is greatest in the early hours of the morning and wakes him up from sleep. The pain is also felt 2-3 hours after meals. He reports diarrhea for the past 2 years and black stools for the past 3 days. On examination, his pulse is 74/min and blood pressure 136/84 mm Hg. There is slight epigastric discomfort on palpation. Lab examination shows occult blood in the stool and hyperchlorhydria. What could be a complication in this patient?

1. Gallstones
2. Intestinal ulcers
3. Pernicious anemia
4. Intestinal alkalosis
5. Weight gain

Answer 1

The likely complication in the patient with severe burning epigastric pain and black stools is intestinal ulcers. Option #2 'Intestinal ulcers' corresponds with the patient's symptoms and lab findings consistent with peptic ulcers that may be bleeding.

Step-by-step explanation:

The patient described is likely experiencing a complication related to peptic ulcers, given the severe, burning epigastric pain that worsens in the early hours of the morning and a few hours after meals, along with reports of black stools and laboratory confirmation of occult blood in the stool. These symptoms suggest the presence of gastric or duodenal ulcers that may be bleeding. Of the options provided, the complication most consistent with the patient's presentation is intestinal ulcers (#2).

Peptic ulcers can lead to complications such as bleeding, as indicated by the black stools, which are a sign of melena—or digested blood passed in stool. This bleeding can lead to anemia but not specifically pernicious anemia, which is caused by vitamin B12 deficiency due to intrinsic factor deficiency or loss, not blood loss. The presence of hyperchlorhydria, or high stomach acid levels, also supports the diagnosis of peptic ulcers. Therefore, the presence of intestinal ulcers is the likely complication occurring in this patient.