An adult client presents with gnawing epigastric pain. The pain is worse when the client is hungry and abates after eating something. Which problem do these symptoms suggest?
A.
Chronic pancreatitis.
B.
Peptic ulcer disease (PUD).
C.
Esophagitis.
D.
Gastroesophageal reflux (GERD).
The correct answer and Explanation is :
The correct answer is B. Peptic ulcer disease (PUD).
Explanation:
The symptoms described—gnawing epigastric pain that is worse when hungry and improves after eating—are characteristic of peptic ulcer disease (PUD). PUD involves the formation of ulcers in the lining of the stomach, duodenum (the first part of the small intestine), or sometimes the lower esophagus, due to the corrosive effects of stomach acid.
Key Symptoms of PUD:
- Epigastric pain: This is the most common symptom. It is often described as a burning or gnawing sensation in the upper abdomen.
- Pain relief after eating: Eating food or taking antacids can temporarily buffer stomach acid, providing relief. This pattern is especially seen with duodenal ulcers, a type of PUD.
- Pain exacerbated by hunger: When the stomach is empty, acid comes into direct contact with the ulcer, leading to increased discomfort.
Risk Factors and Causes:
PUD is primarily caused by an imbalance between the aggressive factors like stomach acid and pepsin and the protective factors of the gastric lining. The two most common causes are:
- Helicobacter pylori (H. pylori) infection: This bacteria disrupts the mucosal lining, making it more susceptible to acid damage.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications can weaken the stomach’s protective lining, increasing ulcer risk.
Differential Diagnosis:
- Chronic pancreatitis (A): Pain typically radiates to the back and worsens after eating fatty foods, differing from PUD.
- Esophagitis (C): Pain is often related to swallowing, and is more localized to the chest.
- Gastroesophageal reflux disease (GERD) (D): GERD involves burning chest pain (heartburn), often after meals or when lying down, but it doesn’t have the same relief pattern with food as PUD does.
PUD’s hallmark symptom is this specific pain pattern, making it the best match in this case.