Clinical Case

Presentation
Objectives

1 2
General Data
● M.S.
● 65 years old male
● married
● Filipino
● retired teacher
● Roman Catholic
● born on January 16, 1957 in Quezon City
● presently residing in Valenzuela City
● brought to Fatima University Medical Center-ER on
April ___, 2022 at 8:05 AM
Epigastric
Pain
Chief Complaint
 History of Present Illness

12 days PTA 5 days PTA

the patient suffered from severe patient noted occasional dark,
knee joint pains due to foul smelling stool
osteoarthritis. He took approximately 3 episodes a day.
Diclofenac 50mg tablets, twice He also experienced
a day, continuously. lightheadedness, nausea, and
loss of appetite. No abdominal
pain and vomiting noted.
 History of Present Illness

2 days PTA 1 day PTA

patient experienced recurrent epigastric pain, With increasing severity of epigastric
described as a burning sensation, with a pain, now reaching a pain scale of 8/10,
pain scale of 6/10, non-radiating, partially and persistence of above symptoms, the
relieved by food, and occurring mostly at patient was prompted to seek
midnight that wakes him up from sleep. He consultation at FUMC-ER and
self-medicated with Kremil S with slight
subsequently admitted.
relief of symptoms. No other symptoms
associated such as dyspnea and cough noted
aside from his continuing symptoms of passing
out dark, foul smelling stool approximately 3
episodes per day. He was continuously taking
Diclofenac for severe knee joint pains.
 Past Medical History

The patient had measles, mumps and chickenpox during childhood.

The patient has complete childhood immunizations. He received his
booster shot of Pfizer vaccine last February 2022. No other
immunizations were administered to him as an adult. He is taking
Amlodipine 5 mg once daily for hypertension with a regular BP of
140/90. The patient denies having allergies to any food or other
substances. The patient denies any history of blood transfusions,
surgery, accidents, injuries, or trauma of any kind.
 Family History

Father, deceased at age 75, with known hypertension and Type 2

diabetes mellitus.
Mother, deceased at age 70 due to gastric malignancy.
He has no history of asthma, psychiatric illness, seizure disorder,
and other heterofamilial disorders.
 Personal and Social History
The patient is a college graduate. He is a retired teacher and has been married for
35 years. He is living with his wife, 60 years old, and apparently well. They have 2
children, both apparently healthy. They live in a bungalow house with 3 bedrooms, 2
comfort rooms, and a well-ventilated area. Their source of water is from Maynilad
and orders purified water for drinking. The garbage is collected 3 times a week. He
consumes 3 cups of coffee everyday. He prefers meat and vegetables. He is a
smoker, consuming 1 pack per day for 20 years. He is an alcoholic beverage
drinker, consuming 2-3 bottles of beer a month since he was 40 years old. He has
no regular exercise. He denies history of illicit drug abuse and sexually transmitted
infections. No other sexual partners aside from his wife.
 Review of Systems
General:(-) fever, (-) malaise, (-) easy fatigability, (-) change in weight
Integumentary: (-) pruritus, (-) excessive dryness or sweating, (-) cyanosis, (-) pallor, (-) jaundice, (-) erythema
Head and Neck: (-) headache, (-) syncope, (-) blurred vision, (-) eye pain or itchiness, (-) photophobia, (-) hearing loss,
(-) tinnitus, (-) ear pain or otalgia, (-) ear discharge, (-) nasal obstruction, (-) epistaxis (-) sinus pain, (-) sore throat, (-)
hoarseness, (-) bleeding gums
Respiratory:(-) dyspnea, (-) cough, (-) hemoptysis, (-) wheezing, (-) phlegm
Cardiovascular: (-) Chest pain, (-) palpitation, (-) orthopnea, (-) paroxysmal nocturnal dyspnea, (-) shortness of breath
Gastrointestinal:(+) Abdominal pain, (+) loss of appetite, (+) dysphagia, (-) diarrhea, (-) constipation, (-) steatorrhea, (+)
blood in stool, (-) hemorrhoids, (-) fecal incontinence, (-) flatulence, (-) vomiting, (-) hematemesis, (+) nausea
Genitourinary:(-) dysuria, (-) flank pain, (-) hematuria, (-) nocturia, (-) polyuria, (-) urinary frequency, (-) urinary
incontinence
Musculoskeletal:(-) muscle pain, (+) joint pain, (+) swelling, (+) stiffness, (-) numbness, (-) intermittent claudication, (+)
limitation of movement
Neurologic:(-) seizures, (-) loss of memory, (-) syncope, (-) tremors, (-) loss of consciousness, (-) focal weakness, (-)
paralysis, (-) numbness, (-) paresthesia, (-) speech disorder, (-) loss of memory, (-) confusion
Endocrine: (-) polydypsia, (-) polyphagia, (-) polyuria
Hematologic: (-) easy bruising, (-) abnormal bleeding
Psychiatric:(-) anxiety, (-) depression, (-) mood change
 Physical Examination

General Survey:
Patient is conscious, cooperative, fairly developed, with good
grooming, ambulatory and not in distress.

Vital signs:
Patient BP is 140/90, HR of 110 bpm, RR of 16 cpm, with a
temperature of 37.2C.
 Physical Examination
HEENT
Normocephalic with sparse cranial hair. Facial skin is brown, symmetric with no abnormal
facies, eyebrows are black, symmetrical. Eyelashes were arranged normally. Palpebral fissures
are symmetrical, no edema. Palpebral conjunctivae are pale. Bulbar conjunctiva are normal.
Sclera are white. Cornea are transparent. Iris are brown and arranged radially. Pupils are
round, symmetrical, 3-4 mm ERTL. Lens are transparent.
Ears are symmetrical, C- shaped. Patent auditory canal without lesions. Intact tympanic
membrane.
Nose. Symmetrical, at the midline. Both nostrils are patent. With moist turbinates.
Mouth: lips are brown, dry with no lesions. The buccal mucosa was normal, moist and pink.
Tongue is normal in size, at the midline. Papillae were visible. Uvula, hard and soft palate as
well as posterior pharyngeal wall were normal.
Neck: Symmetrical at the midline. No masses, no palpable lymph nodes. Thyroid not palpable.
 Physical Examination

Chest/lungs: thoracic cage is symmetrical, elliptical in shape, no skin

lesions noted, no spider angiomata. Not tachypneic, no intercostal
retractions. Resonant on both lung field. Equal Tactile and vocal
fremitus on both lung fields. Equal breath sounds. No rales/crackles
noted.

CVS: No bulging nor depression in the anterior chest wall.PMI is

located at the 5th ICS MCL. No heaves, thrills, lifts. Tachycardia,
regular rhythm. No murmurs. Full and equal peripheral pulses
 Physical Examination

Abdomen: Flat, symmetrical. No scars nor lesions noted.

Normoactive bowel sounds. No bruit. No shifting dullness, no fluid
wave. Soft, non- tender, no palpable organs. No masses palpated.
Negative Murphy’s, Psoas, obturator, Rovsing’ signs.

Extremities: Symmetrical, no deformities noted.

Neurological: No abnormalities noted.

Peptic Ulcer
Disease
Initial Impression
Basis
(+) Abdominal pain
(+) loss of appetite
(+) dysphagia, (+) blood in stool, (+) nausea
(+) joint pain, (+) swelling, (+) stiffness,
(+) limitation of movement
(+) pallor
(+) direct tenderness upon palpation in epigastric area.
DIFFERENTIAL
DIAGNOSIS
GERD
Rule In Rule out
Acute Pancreatitis
Rule In Rule out
Gastritis
Rule In Rule out
Acute Cholangitis
Rule In Rule out
DDX:
STEF. CAPITULO

Rule In Rule out

DDX: Acute Pancreatitis
FRANZ

Rule In Rule out

DDX:
DANIKA

Rule In Rule out

DDX:
NIKKO

Rule In Rule out

DDX:
ERICKA

Rule In Rule out

DDX:
ANGEL

Rule In Rule out

DDX:
MARIANNE

Rule In Rule out

DDX:
ADOLFO

Rule In Rule out

DDX: Myocardial Infarction
JIA

Rule In Rule out

Pathophysiol
ogy
Epidemiology
90%
Despite being red,
Mars is very cold

30%
Jupiter is the
biggest planet

80%
Saturn is the ringed
planet
DIAGNOSTIC
WORK-UPS
Laboratory Work- up
Diagnostic Modality
Management
Pharmacologic Management
Non- Pharmacologic Management
Concept Map
References
Thanks!
Do you have any questions?
 333,000
24h 37m
Earths is the Sun’s mass

23s Is Jupiter’s rotation period

386,000 km
Distance between the Earth and the Moon