A 42-year-old man, complaining of a severe upper abdominal pain, checked himself into the Emergency Department (ED) ofa hospital.
He described the pain as intermittent over the past 10 days and complained that it causes him to wake up during the night.
However, the pain had now acutely worsened and was radiating throughout the patient's upper abdomen and extending to his back.
The patient stated that the pain increases when he islying flat on his back and slightly improves when in an upright sitting position. He also complained of suffering from mild nausea without vomiting. When asked, he replied that he suffered from none of the following symptoms:
The patient suffers from no chronic medical conditions and does not use any medications including non-steroidal anti-inflammatory drugs (NSAIDs).
He was however, a smoker and drinksbeer on a daily basis.
Upon physical examination, the patient is noted to be a thin, slightly emaciated man. His vital signs include:
The patient is notably sweaty. The examination reveals the following:
After completing the examinations the patient is urgently placed on a cardiac monitor and is given two doses of IV morphine, which offer no significant improvement of pain or tenderness.
An upright, anterior/posterior chest radiograph is then obtained, and shows no air visualized under the diaphragm.
An abdominal ultrasonography is conducted and shows normal results. All laboratory investigations, take are within normal limits. The tests included:
An electrocardiogram (ECG) revealed a normal sinus rhythm at a ventricular rate of 88 beat/min, with nonspecific ST flattening in the lateral leads and showed no change from his prior ECG.
After the initial workup is completed, an additional dose of IV pain relief drug is administered to the patient, which provides some improvement of the pain (although focal epigastric tenderness persists).
The computed tomography (CT) scan of the abdomen and pelvis with oral and IV contrast images are then obtained (see Figures 1 and 2).
1. What is the cause of the patient's acute abdominal pain?
2. What is the clue for the diagnosis?
3. Symptoms of Gastroesophageal Reflux Disease “GERD” include:
4. Complications of GERD include:
5. The ultimate goal of treatment of GERD is:
6. Proton Pump Inhibitors “PPIs” are the most potent inhibitors of acid secretion available.
7. For how many hours Pantoprazole (if indicated for this case) maintains pH more than 3 in cases of Peptic ulcers?
8. What is the unique binding site of Pantoprazole?
9. Half time recovery of acid secretion with pantoprazole reaches to…………
10. The longer inhibition of acid secretion of pantoprazole is mainly due to