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