please help with all questions if possible A 28-year-old graduate student compla
ID: 253771 • Letter: P
Question
please help with all questions if possible
A 28-year-old graduate student complained of a dull pain (heartburn), burning, and "gnawing" behind the sternum. The pain was postprandial (occurred after meals) and disappeared within a few minutes to an hour after eating a meal. It was often associated with excessive belching and often was worse with lying down or on exertion after heavy meals. Sometimes it radiated to the back, jaws, shoulders, and down the inner aspects of the arms, simulating chest pain and discomfort. X-rays revealed a small portion of the stomach above the diaphragm, and a biopsy revealed mucosal inflammation. Esophageal manometry (determining pressures at the lower esophageal sphincter, LES) revealed decreased LES pressure. Esophageal pH monitoring showed reflux of gastric contents into the esophagus and provided direct evidence of gastroesophageal reflux. Recommended treatment for this individual is avoidance of strong stimulants of gastric acid secretion (e.g., coffee, alcohol) and avoidance of certain drugs (e.g. anticholinergics), and specific foods (fats, chocolates, whole milk, and orange juice), and smoking, all of which reduce LES competence. Elevation of the upper body of about six inches while lying in the bed was also recommended. Suggested treatments were anti-acid medications and anti-nausea medications Bethanechol and Cimetidine. Please answer the following questions. 1. What is the disorder of this 26 year old graduate student? Explain 2. What mechanisms usually prevent the reflux of gastric acid into the esophagus? 3. Which medications are recommended to take and not to take for this condition? 4. Why are Histamine H2 antagonists recommended for this condition? 5. What is the normal pH of the esophagus and the stomach? 6. Why is it recommended to elevate the bed for this condition? 7. What is the graduate student at risk for developing if this condition is untreated?Explanation / Answer
1. This girl is suffering from GERD disease i-e gastroesophageal reflux disease. In this condition the stomach acid refluxes back into the esophagus and causes pain.
2 pressure difference between the chest and diaphragm, flat abdominal muscles and lower esophageal sphincter prevent refluxing back of acid from stomach into the esophagus.
3.medicines like omperazole, pantaperazole, rabeperazole and esamoperazole, antacids like rantidine, famtodine are recommended for this condition whereas aspirin, ibuprofen, naproxin are not recommended.
4.H2 antagonists block the action of histamine on acid producing cells so that the quantity of acid is reduced within the stomach.
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