Chronic GI/GU Condition Case Studies
Scenario 1

The primary diagnosis in the present scenario would be gastroesophageal reflux disease (GERD). The diagnosis in this case has been made on the strength of the presenting symptoms. According to the National Institute of Diabetes and Digestive and Kidney Diseases – NIDDK (2014), some of the symptoms associated with GERD include a “regular heartburn, a painful, burning feeling in the middle of your chest, behind your breastbone, and in the middle of your abdomen.” The 46-year-old male in this case presents the very same symptoms. In essence, the symptoms that the patient presents are as a consequence of the flow-back stomach contents/stomach from his stomach into his esophagus. Given that this is something that has been happening over the past couple of months, the lining of his esophagus is irritated – hence the need for immediate medical attention to ease symptoms. The differential diagnosis in the present scenario would be peptic ulcer disease- specifically gastric ulcers. These are essentially open sores on the stomach’s inner lining. A person suffering from gastric ulcers is likely to experience discomfort in the middle of his abdomen – described as a burning sensation. The alternative diagnosis could also be inclusive of gastroparesis, dyspepsia, and gastritis.

To ascertain the primary diagnosis, it would be prudent to conduct additional diagnostic testing. In this case, an upper endoscopy would come in handy in the examination of the 46-year-old’s esophagus and stomach. In the case of GERD, this would most likely reveal esophagitis. This diagnostic procedure also permits biopsy – in which case the tissue collected could be assessed further, i.e. for Barrett's esophagus. Other diagnostic procedures that could be taken into consideration include, but they are not limited to, upper digestive system x-ray and esophageal manometry.

Treatment in this case would be include of both pharmacological and nonpharmacological interventions. The most appropriate pharmacological interventions in the present scenario would be drugs to block the production of acid. This is more so the case given that the 46-year-old has in this case been experiencing the symptoms for the past couple of months and as he points out, the pain in his mid-chest has worsened over the last few weeks. There is need to ensure that his esophagus heals by blocking acid production. In this case, proton pump inhibitors would be effective. Thus, omeprazole (Zegerid OTC) would be appropriate. Additionally, to ease GERD, Baclofen would be considered due to its ability to ensure that the lower esophageal sphincter is...…the patient, i.e. frequent urination. Differential diagnosis in this case would be diabetes and prostate cancer.

To ascertain the BPH diagnosis, physical exam and, if necessary, further tests to verify prostate enlargement would come in handy. The said physical exams could comprise of a digital rectal examination. Further, to ensure that the presenting symptoms are not triggered by an infection, a urine test could be conducted. In some instances, it might be necessary to undertake a prostate biopsy.

The appropriate approach to treatment in this case would be dictated by quite a number of considerations that include; overall health, age, and how large the prostate is. In the present scenario, a combination drug therapy would be considered. The said drug therapy would be inclusive of finasteride (Proscar) – which is essentially a 5-alpha reductase inhibitor (to reduce prostate size); and tamsulosin (Flomax) – which is an alpha blocker (to ease urination). As part of patient education, the patient would be advised to; minimize alcohol and caffeine intake as these do increase the production of urine, minimize his use of medication that can cause the tightening of some urethra muscles (i.e. antihistamines and decongestants), and embrace the appropriate diet to minimize chances of obesity (which has been linked to prostate enlargement).…