Question

History: 60-year old female complains of epigastric pain that occurs about 2 hours after meals. She states it is a burning sensation, sometimes relieved with antacids. She also complains of bloating and fullness, has smoked one pack of cigarettes/day for 20 years. She does have a glass of wine with her evening meal. She has taken ibuprofen for arthritis pain in her left knee for about 4 years. She thinks her father had an ulcer. She is currently taking lisinipril 10 mg po daily for hypertension and Unidur 400 mg for mild COPD.

1. What is her pack year history?


2. What factors can you identify that help in making a differential diagnosis?


3. Following endoscopy, your patient is diagnosed with a duodenal ulcer. Discuss the advantages and disadvantages of the following drug therapy.

Answer 1

A 60-year-old woman with a smoking history of 20 pack-years presents with symptoms indicative of a duodenal ulcer, which can be influenced by her lifestyle choices and medication use. Smoking and persistent use of ibuprofen are particularly relevant for making a differential diagnosis. Upon diagnosis, treatment may involve antacids and antibiotics, with consideration for potential medication side effects and interactions.

Step-by-step explanation:

Pack Year History and Differential Diagnosis

The pack year history for the 60-year-old female patient who has smoked one pack of cigarettes per day for 20 years is 20 pack-years. This is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked.

Factors for Differential Diagnosis

The factors to consider in making a differential diagnosis include her symptoms of epigastric pain, bloating and fullness, the temporal relationship of the pain to meals, relief with antacids, smoking history, alcohol consumption, chronic use of ibuprofen, and family history of an ulcer. Her current medications, lisinopril for hypertension and Unidur for COPD, should also be considered.

Drug Therapy for Duodenal Ulcer

When the patient is diagnosed with a duodenal ulcer following endoscopy, the advantages of drug therapy might include symptom relief through antacids and the healing of ulcers with the avoidance of NSAIDs or the treatment of H. pylori infection with antibiotics. Disadvantages may include side effects from medications, potential interactions with her current medications, and recurrence if underlying issues such as smoking and NSAID use are not addressed.