Case Study Of Patient Complaining Of Intermittent Nocturnal Gastroesophageal Reflux

Case Study Of Patient Complaining Of Intermittent Nocturnal Gastroesophageal Reflux

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1) Lesson 5

Complaint: “My heartburn has been waking me up at night.”

A 47-year-old male patient presents to the clinic with complaints of intermittent nocturnal gastroesophageal reflux. History reveals that he awakens experiencing burning pain substernally and in the back of his throat. This results in “my larynx closing down” and his being “almost unable to breathe.” As soon as he can breathe effectively, he swallows “a lot” of antacid and flushes it down with water. The entire episode is very frightening, and he is often afraid to go back to sleep. Because he already has a problem with mild sleep apnea, he is becoming increasingly tired and unable to function at work due to lack of sleep. He now sleeps only in his recliner. He is also concerned about the substernal pain because his father had a myocardial infarction at age 49 and required coronary artery bypass surgery. He is 5 feet 9 inches tall and weighs 220 pounds (body mass index [BMI] is 32.5), with much of his excess weight carried in his abdomen. He is not a smoker, “occasionally” has three or four beers with friends, and “often” has pizza or submarine sandwiches for lunch with a “diet cola.” He takes no drugs other than the antacid after a reflux episode. Assessment A chest x-ray and electrocardiogram are negative for cardiopulmonary disease, and Greg is diagnosed by history with gastroesophageal reflux disease (GERD)Case Study Of Patient Complaining Of Intermittent Nocturnal Gastroesophageal Reflux.

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What would be the initial management plan for GERD?
What education does the patient need?

2)Lesson 6: DiscussionContains unread posts
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Case Study

A graduate student has noticed that despite numerous unhealthy snacks weekly as a method to cope with their studies, they are losing weight. They attributed the faster pulse and “jitters” to the cups of coffee, several Red Bull drinks, and No Doz pills used to pull all-nighter study sessions. At first, they thought any nervousness was anxiety about school, but they present today believing “the stress” of school is so high they have trouble sleeping, cannot sit still, and is having problems concentrating. They have a sore throat that is different from a typical one because it appears to hurt only on the anterior aspect of the neck, not deep in the posterior mouth.

Which thyroid disorder(s) comes to mind?
What labs/imaging need to be ordered?
What medication alternatives need to be considered when you discover that they are 3 months pregnant?
What other differential diagnoses come to mind? Case Study Of Patient Complaining Of Intermittent Nocturnal Gastroesophageal Reflux

Gastroesophageal Reflux Disease

1. What would be the initial management plan for GERD

The initial management plan for the condition requires patient evaluation to determine the severity of the disease and design a management plan that addresses the specific pathological process and complications. Therefore, it is necessary to perform an esophagogastroduodenoscopy (EGD) to evaluate the presence of complications such as Barret’s esophagitis, carcinoma, esophagitis, and esophageal sphincter. After evaluation, pharmacotherapy measures such as using proton pump inhibitors (PPIs) may be administered to help reduce the amount of acid (Clarrett & Hachem, 2018). The proton-pump inhibitors may quickly relieve symptoms if the patient has uncomplicated reflux disease.

2. What education does the patient need?

The patient requires information regarding the strategies he should apply to minimize the severity of symptoms and prevent disease progression. The components of patient education may include minimizing intake of spicy foods to reduce the severity of features, taking smaller and more frequent meals, minimizing alcohol intake, reducing intake of carbonated drinks, avoiding lying down immediately after eating, and taking smaller frequent meals. In addition, the patient must understand the role of weight in the disease progression (Chhabra & Ingole, 2022)Case Study Of Patient Complaining Of Intermittent Nocturnal Gastroesophageal Reflux. Thus, the patient must learn the effects of uncontrolled weight and be supported to attain a healthy weight.

Thyroid Disorder

1. Which thyroid disorder(s) comes to mind?

The thyroid disorder that manifests in this case is hyperthyroidism. In this disorder, the thyroid gland produces excessive amounts of thyroid hormones, affecting the body’s homeostasis. Consequences of hyperthyroidism that manifest in this case include insomnia, decreased attention span, weight loss due to increased metabolism, anxiety, tremors, restlessness, and tachycardia (Shahid & Sharma, 2019)Case Study Of Patient Complaining Of Intermittent Nocturnal Gastroesophageal Reflux. The patient also reports discomfort in the neck, which suggests thyroid enlargement; hence the cause of hyperthyroidism may be goiter.

2.      What labs/imaging need to be ordered?               Diagnostic investigations that may be required for this case include thyroid function tests, laboratory evaluation of the thyroid stimulating hormones, serum T3, and T4. Antithyroid antibodies and antithyroglobulin antibody testing are necessary to trace the autoimmune origin of the disease, such as in Grave’s disease and Hashimoto’s thyroiditis. Radiological investigations, on the other hand, may involve radioactive iodine reuptake testing, thyroid scan, and neck ultrasound (Shahid & Sharma, 2019)Case Study Of Patient Complaining Of Intermittent Nocturnal Gastroesophageal Reflux. Radiological tests are used to evaluate the integrity of the thyroid gland and classify the disease.

3. What medication alternatives must be considered when you discover they are 3 months pregnant?

Safety considerations for special populations such as pregnant women must be evaluated before initiation of therapy for hyperthyroidism. During the first three months, the patient should use propylthiouracil (PTU) may be used because its safe and does not have significant teratogenic effects (Petca et al., 2023). On the other hand, after the first three months, the provider may educate or support the client to initiate or continue with methimazole therapy since it is generally safe after the first trimester.

4.      What other differential diagnoses come to mind?

The patient presents with insomnia, restlessness, tremors, decreased attention span, and high-stress levels in some mental health and psychiatric conditions. These conditions include generalized anxiety disorder, panic attacks, and attention deficit hyperactivity disorder (ADHD) (Yasuda et al., 2021). Therefore, a thorough evaluation is necessary for making the most accurate diagnosis that results in an effective diagnosis.

References

Chhabra, P., & Ingole, N. (2022). Gastroesophageal reflux disease (GERD): Highlighting diagnosis, treatment, and lifestyle changes. Cureus. https://doi.org/10.7759/cureus.28563

Clarrett, D. M., & Hachem, C. (2018). Gastroesophageal reflux disease (GERD). Missouri Medicine, 115(3), 214–218. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140167/#:~:text=Gastroesophageal%20reflux%20is%20primarily%20a

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Petca, A., Dimcea, D. A.-M., Dumitrașcu, M. C., Șandru, F., Mehedințu, C., & Petca, R.-C. (2023). Management of hyperthyroidism during pregnancy: A systematic literature review. Journal of Clinical Medicine, 12(5), 1811. https://doi.org/10.3390/jcm12051811

Shahid, M. A., & Sharma, S. (2019). Physiology, thyroid hormone. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK500006/

Yasuda, M., Kumakura, J., Oka, K., & Fukuda, K. (2021). A case of thyroid storm caused by Graves’ disease misdiagnosed as panic attack due to panic disorder. Biopsychosocial Medicine, 15(1). https://doi.org/10.1186/s13030-021-00211-4 Case Study Of Patient Complaining Of Intermittent Nocturnal Gastroesophageal Reflux