Case Studies: Patient 1
A 48 year-old lady has been suffering from epigastric discomfort, heartburn, bloating, early satiety following meals, belching, nausea and has had three episodes of vomiting over the last 2 years. She has lost 3 kg of weight, but this was intentional due to regular exercise and a balanced diet.
She is a non-smoker and a social drinker and has no other co-morbidities. She has no known causes of anxiety and is a very amiable person.
She has been on lansoprazole and esomeprazole for 6 months. She is not on any painkillers.
She has had a breath test for H.Pylori and upper GI endoscopy six months ago, which was negative. She recently had an ultrasound scan, which was negative for gallstones. She has been referred to a gastroenterologist in a district general hospital.
This case study was written for illustrative purposes only
How would you manage this patient?
Gastroenterologist perspective on the next page
Case Studies: Patient 1
Overview of Patient 1
Professor Domínguez-Muñoz
Director,
Department of Gastroenterology,
University Hospital of
Santiago de Compostela,
Santiago de Compostela, Spain
The views expressed are of the healthcare professional and not the hospital where they work. See Disclaimer for more information.
Case Studies: Patient 2
A 48 year old man, with a long history of alcohol dependency. Unkempt and with poor nutritional status, he has been admitted four times over the past two years with attacks of acute pancreatitis. He presented with epigastric pain radiating to the back, with vomiting and dehydration and was diagnosed using elevated serum amylase of >1000 IU/L.
Though none of these admissions required intensive care, he now complains of chronic epigastric pain and diarrhoea and has had non deliberate loss of 5% of his body weight. He has not been able to hold onto his job as a sales assistant at a local superstore. He now has had a period of detoxification and is doing well. Further evaluation has shown evidence of malnutrition.
A random glucose showed 11.8 mmol/l and he has now been referred for a fasting blood sugar test. A faecal elastase test showed 20 µg/g.
He underwent an ultrasound scan of the abdomen which was unremarkable and a CT scan which showed calcifications, but no mass lesions or cysts. Subsequent endoscopic ultrasound has shown evidence of chronic pancreatitis.
This case study was written for illustrative purposes only
How would you manage this patient?
Dietitian perspective on the next page
Case Studies: Patient 2
Overview of Patient 2
Mary Phillips
Specialist Dietitian, Royal Surrey County Hospital, Guildford, UK
The views expressed are of the healthcare professional and not the hospital where they work. See Disclaimer for more information.
Case Studies: Patient 3
A 43 year-old female presented with eight bouts of severe abdominal pain radiating to the back, which necessitated hospital admission over the last two years. This was accompanied by nausea and vomiting. Though serum amylase was mildly raised in all occasions, in only three of the episodes, were they more than three times above normal.
Previously intermittent abdominal discomfort and diarrhoea has now becoming chronic. Clinically, she had poor nutritional status and had 5 kg unintentional weight loss. She did not have any history or evidence of alcoholism. She is a smoker, smoking about 30 rolled tobacco cigarettes a day. She worked as an office clerk, but has been on sick leave for the last 3 months.
Investigations showed mild anaemia, normal U&E and LFTs. Ultrasound and CT scan of her abdomen was unremarkable. A subsequent endoscopic ultrasound showed evidence of chronic pancreatitis. Her GP started her on pancreatic exocrine replacement therapy at a dose of 10,000 lipase units per meal. The improvement was marginal initially and she continued to have symptoms.
This case study was written for illustrative purposes only
How would you manage this patient?
Gastroenterologist perspective on the next page
Case Studies: Patient 3
Overview of Patient 3
Mary Phillips
Specialist Dietitian, Royal Surrey County Hospital, Guildford, UK
The views expressed are of the healthcare professional and not the hospital where they work. See Disclaimer for more information.
Case Studies: Patient 3
A 46 year-old Caucasian lady, 5`6” tall, weighing 80 kg has recently been diagnosed with type II diabetes. After a period of dietary control and exercise, she is started on metformin. In the past, she has seen her doctor for 'IBS-type symptoms' 3 years ago, which has been waxing and waning over time, but has never been completely relieved.
She is self-employed and runs a small convenience store. She has no known anxieties, is happily married with two children, a boy aged 9 and a girl aged six.
She has now presented with diarrhoea to her GP. Her doctor orders HbA1C, full blood count, wall echo shadow, liver function tests, C-reactive protein test, thyroid function tests, immunoglobulins, tissue transglutaminase antibody and endomysial antibody and sends a request to the Gastroenterologist at the District General Hospital for a colonoscopy.
This case study was written for illustrative purposes only
How would you manage this patient?
Gastroenterologist perspective on the next page
Case Studies: Patient 4
Overview of Patient 4
Professor David Sanders
Consultant Gastroenterologist, Royal Hallamshire Hospital and University of Sheffield, UK
The views expressed are of the healthcare professional and not the hospital where they work. See Disclaimer for more information.
References
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