Case Study: Digestive Upset

Case Study: Digestive Upset in a 28-Year-Old Patient

Summary: A 28-year-old presented with heartburn, worsening abdominal pain, and melena. Daily ibuprofen use was the only med history. Findings support peptic ulcer disease (PUD) with an upper GI bleed, likely gastric or duodenal.Also considered alternative symptom of hematochezia and the differing outcome.

Patient Presentation

CategoryDetails
Age/Sex28 years old
Chief Complaint“Bad heartburn” and generalized abdominal pain, worsening over time
Associated SymptomBlack stools (melena)
HPIGradual worsening abdominal discomfort; dark stools noted recently
PMHChronic shoulder pain (ski injury)
MedsDaily ibuprofen (NSAID)
AllergiesNKA/NKDA

Initial Diagnosis & Reasoning

Primary dx: Peptic Ulcer Disease (gastric or duodenal)
Likely structures: Stomach or proximal duodenum

  • NSAID use: COX-1/COX-2 inhibition → ↓ prostaglandins → ↓ mucosal protection → ulcer risk.
  • Melena: Points to upper GI bleeding from ulceration.
  • No other comorbidities: Supports drug-induced etiology.

Next steps: Upper endoscopy (EGD) and H. pylori testing.

Peer Discussion Highlights

  • Consensus: PUD + upper GI bleed due to chronic NSAID use.
  • Differentials raised: Gastritis/esophagitis; GERD (later revised to PUD).
  • Management themes: Stop NSAIDs, start PPI, EGD, test/tx H. pylori.

Final Conclusion

Maintained initial diagnosis: PUD with upper GI bleed.
If stool had red blood (hematochezia), prioritize lower GI sources (hemorrhoids, diverticulosis, IBD, malignancy) and add a colonoscopy.

References