50 yr old female with epigastric pain for 2 weeks with history of DM, HTN, OA.
HISTORY QUESTIONS
pain
onset
duration
relieving or aggravating factors
characteristic of pain
medication history
over the counter medication
antacids, PPI, H2 blockers
any medication that induce esophagitis
antibiotics
nsaids
iron
ascorbic acid
alendronate
smoking and alcohol history
weight loss, dysphagia, diarrhoea
dietary history
Physical Examination
vitals
pulse
respiratory rate
blood pressure
temperature
weight
inspection
mouth -- dental erosions
swallowing ability
palpation
hepatomegaly
splenomegaly
tenderness or distension
masses
auscultation for gut sounds
investigations
cbc
LFT
testing for H. pylori
chest X ray
24 hr intraluminal ph monitoring
manometry
barium swallow
esophagoscopy
Differential Diagnosis and their Treatments
GERD
antacids, PPI, h2 blockers, lifestyle modification
gastrtitis
antibiotics, PPI, h2 blockers, antacids
angina/MI
nitrates
cholecystitis
fasting, fluids, antibiotic, pain medication
peptic ulcers
antacids, PPI, H2 blockers
esophagitis