A 61-year-old American woman was referred to a Gastroenterology Clinic from primary care provider due to consistent discomfort and significant weight loss. She looked for a PCP’s advice as she had a tarry stool in the early morning which she had never experienced before. She presented with a 2-month history of burning pain in the epigastric abdomen and chest which radiated toward her back. Her pain worsened after taking aspirin and drinking coffee, and was relieved after taking antacids. She had previously lost 10 pounds in 2 months due to decreased intake caused by the feeling of bloating, early fullness and stomachaches between meals. She also reported nausea and vomiting. She expressed concern especially because the food appeared undigested when she vomited. She also reported doubling her NSAID intake due to increased knee pain. She looked pale and exhausted when she entered the clinic.
Vital Signs and Measurements
- BP: 135/85 mm Hg
- HR: 99 bpm
- RR: 21 b / min
- Temperature: 36.1 ℃
- Pulse oxygenation: 99%
- Height: 167 cm
- Weight: 58.2 kg
Past medical history
- Gastritis with Helicobacter pylori (H. pylori) infection, diagnosed 5 years ago. Resolved with pharmacotherapy, frequent recurrence.
- Heart attack 3 months ago, has started taking aspirin since then.
- Osteoarthritis, diagnosed 3 years ago. Long-term use of the non-steroidal anti-inflammatory drug (NSAID) since diagnosis.
- Acute pancreatitis 5 years ago, resolved with pharmacotherapy, no recurrence.
- Chronic obstructive pulmonary disease, diagnosed 11 years ago.
- Diabetes Mellitus and hypertension diagnosed 6 years ago.
- No surgical history.
Pertinent family history
- Mother died from gastric cancer at age 67 years old.
- Father alive, has smoked for 50 years and now has a small-cell carcinoma. Live with the patient since she divorced her husband.
- Brother alive and well at age 56 years, had a history of duodenal ulcers. Heavy smoker.
- Ex-husband at age 62, alive and has COPD.
- One son alive and well at age 29.
- One daughter at age 35, alive and has recurrent Gastritis.
Pertinent social history
- Has worked full-time as a TV program producer for 30 years.
- Divorced with her husband 20 years prior, raised 2 children by herself.
- Hobbies include drinking, eating spicy food, watching dramas and talkshow.
- Has smoked for 30 years, even after the diagnosis of COPD, still cannot quit smoking.