Case

A 42-year-old complains of abdominal pain that began intermittently about 6 months in the upper left quadrant.  Recently the pain has become low level constant in nature, with enhancement of the pain shortly after meals including a sharper mid left back pain most recently.  They also report heartburn that has been occurring during the previous year which is also more prominent shortly after meals now.  The patient has been self-medicating with over-the-counter antacids, which have been providing some relief. They states his stools have changed in color over the previous month and now are intermittently dark and tarry in consistency. Tests of the patient’s stool finds occult blood (‘occult blood’ is blood that is not visible to the naked eye). 

Question 1/3 - What is the most likely diagnosis?

Click on your selected option(s) below  (correct = 2, over-thinking = 3+)

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Correct! The slow onset 'heartburn' symptoms shortly after a meal alleviated by over the counter antacids are consistent with gastroesophageal reflux disease (GERD).

The dark and tarry stools reflect occult blood in the stools from hemoglobin which has been partly digested (which is called ‘melena’). This is suggestive of an upper gastrointestinal bleeding disorder.

Incorrect. While ischemic colitis can cause upper left quadrant pain, the condition is acute and life threatening emerging over hours. Thus, ischemic colitis is not consistent with symptoms slowly emerging condition spanning 6 months.

Incorrect. Peritonitis is a generalized inflammatory response throughout the abdominal cavity. Pain would be more widely localized. Additionally, antacids would have negligible effect on generalized peritoneal inflammation and pain.

Incorrect. The appendix is in the lower right quadrant where classic appendix pain localizes.

Incorrect. While heart ischemic pain may refer to the epigastrium near the upper left quadrant, a cardiac ischemic event would not result in blood within the stool.

Correct! The slow onset 'heartburn' symptoms shortly after a meal alleviated by over the counter antacids are consistent with peptic ulcers.

The dark and tarry stools reflect occult blood in the stools from hemoglobin which has been partly digested (which is called ‘melena’). This is suggestive of an upper gastrointestinal bleeding disorder.