Presenting Complaints

• Abdominal pain

History of Presenting Complaint

• The patient is a 40-year-old male who presents with a 2-week history of worsening abdominal pain.
• The pain is located in the epigastric region and is described as a dull, aching sensation that is present throughout the day.
• The pain is sometimes relieved by taking over-the-counter antacids, but it often returns shortly after.
• The patient also reports experiencing nausea, especially in the mornings, but he has not had any vomiting.
• He notes that his appetite has decreased and he has lost about 5 pounds over the past month.
• The patient denies any history of fever, chills, diarrhea, or constipation.

Significant Positives & Negatives For Differentials

Peptic Ulcer Disease

Positives:

• Epigastric pain that is sometimes relieved by antacids
• Nausea, especially in the mornings
• Unintentional weight loss
• Recent travel history to Bali raises possibility of H. pylori infection

Negatives:

• Lack of other gastrointestinal symptoms like diarrhea or constipation
• No history of prior peptic ulcers or gastrointestinal bleeding

Gastritis

Positives:

• Epigastric pain
• Nausea
• Possible association with recent travel to Bali

Negatives:

• Lack of other typical gastritis symptoms like vomiting, heartburn, or early satiety
• No history of chronic NSAID use or alcohol abuse

Irritable Bowel Syndrome (IBS)

Positives:

• Abdominal pain
• Lack of other concerning gastrointestinal symptoms

Negatives:

• Absence of typical IBS symptoms like altered bowel habits, bloating, or changes in stool consistency
• Unintentional weight loss is not a common feature of IBS

Inflammatory Bowel Disease (IBD)

Positives:

• Abdominal pain
• Unintentional weight loss

Negatives:

• Lack of other typical IBD symptoms like diarrhea, rectal bleeding, or systemic symptoms
• No personal or family history of IBD

Gastroesophageal Reflux Disease (GERD)

Positives:

• Epigastric pain that is sometimes relieved by antacids
• Nausea

Negatives:

• Absence of typical GERD symptoms like heartburn, regurgitation, or dysphagia
• Unintentional weight loss is not a common feature of GERD

Functional Dyspepsia

Positives:

• Epigastric pain
• Nausea
• Lack of other concerning gastrointestinal symptoms

Negatives:

• Unintentional weight loss is not a typical feature of functional dyspepsia
• Symptoms have been present for 2 weeks, which may be longer than the typical presentation of functional dyspepsia

Past Medical History

• Unremarkable, no prior hospitalizations or surgeries

Drug/Medication History

• Takes occasional over-the-counter antacids for his abdominal discomfort
• No other regular medications

Social History

• Works as an office clerk, sedentary job
• Denies any alcohol, tobacco, or recreational drug use
• Recently returned from a 2-week vacation in Bali, Indonesia

Family History

• No known family history of gastrointestinal disorders

Systems Review

• Positive for nausea, decreased appetite, and unintentional weight loss
• Negative for fever, chills, diarrhea, constipation, or other associated symptoms

Ideas, Concerns & Expectations

• The patient is concerned that he may have developed some type of stomach or digestive issue, possibly related to his recent travel to Bali. He is hoping the doctor can provide a diagnosis and appropriate treatment.

Case Presentation

Based on the patient's presenting symptoms, medical history, and the analysis of the potential differential diagnoses, the most likely diagnosis is peptic ulcer disease. The recent travel history to Bali raises the possibility of an infectious etiology, such as Helicobacter pylori. Further workup with upper endoscopy and H. pylori testing would be the next appropriate steps to confirm the diagnosis and guide treatment.