The patients high intake of fried foods may be a precipitating factor as the

The patients high intake of fried foods may be a

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cups of coffee a day which can contribute to GERD. The patient’s high intake of fried foods may be a precipitating factor as the high fat content causes symptoms to occur postprandially. The supine position exacerbates heartburn which Mr. Brooks has been experiencing recently. 2) Hiatal Hernia- Is a possible diagnosis because it causes pain in the epigastrium to lower chest. It also worsens in the supine position. It is also associated with obesity. Physical examination is typically normal with hiatal hernias though if large enough dullness on percussion over the left lung base or bowel sounds in the chest may be present. This is not likely the diagnosis as antacids would not relieve the pain. If the patient failed a PPI trail and an endoscopy exam was negative then a barium swallow study may be indicated. 3) Functional heartburn- May be a diagnosis for Mr. Booth as the symptoms are similar to heartburn associated with GERD but are not related. A physical exam is normal just as with GERD and a hiatal hernia. However, an endoscopic exam and pH monitoring would both show normal findings. 4) Dyspepsia- May also be a possible diagnosis based on the epigastric burning postprandial However, epigastric tenderness may be present and burning pain is confined to the epigastrium. Heartburn is a symptom of dyspepsia but not the predominate symptom. Other symptoms of dyspepsia include abdominal bloating, nausea, vomiting, belching, and early satiation which were not present with Mr. Booth. 5) Stable angina- Causes chest pain which could be considered heartburn and therefore a possible diagnosis. Mr. Booth stated that he has been recently experiencing stress related to his job. Stress can cause the onset of stable angina and exacerbate it will continued exposure. Stable angina should be considered if diagnostic studies are all normal, including endoscopic exam. However, there are other factors that are not present with Mr. Booth such as radiation of pain to the left shoulder and arm, neck, or jaw. Physical findings include possible shortness of breath, diaphoresis and a transient S4 gallop when pain is present. An ECG during an episode of pain may confirm or rule out stable angina. References
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Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel's guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby. Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby. Richter, J. E. (2011). Advances in GERD: diagnosis and management of esophageal chest pain. Gastroenterology & Hepatology , 7 (1), 50-51 2p. Retrieved from Walden Library databases.
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