Case for SGD (Dec 7, 2021)

In your small groups, discuss the following case and answer the following details. Prepare a
short presentation (ppt) to be shared to the class (10 mins max).

PU, 48, single, male, bank manager

• Non-diabetic, known hypertensive on maintenance meds (Telmisartan 40 mg OD) with
good compliance, with relatively good functional capacity
• Came to the clinic complaining of epigastric discomfort
- on and off for the last 6 months, burning/gnawing in the character, non-radiating,
usually 2 hours after food intake or at midnight, relieved by intake of antacids,
associated with slightly decreased appetite
- Denies fever, headache, chest pain, dyspnea, vomiting, weight loss, nocturia, polyuria,
changes in BM/stool caliber, blood in the stools
• Enjoys eating street foods, consumes alcohol beverages regularly (3 x a week), previous
smoker, drinks at least 3 cups of coffee.
• PE: BP 130/80, HR 82 regular, RR 16 cpm, T 36.8C; comfortable, not in distress
• Neck/chest/heart findings unremarkable.
• Abdomen soft, with normoactive bowel sounds, with minimal tenderness in the
epigastric area, no rebound tenderness.
• Neurologic exam unremarkable.

1. What is the most likely diagnosis? Provide basis.

2. What differential diagnoses should you consider (give at least three)? Indicate the
points for and against such diagnoses.
3. What are the risks factors that are associated with your primary diagnosis?
4. What laboratory workups and ancillary procedures are needed to support your
diagnosis and rule out the differentials?
5. How would you manage this case? What non-pharmacologic advice would you give
this patient?
6. What complications should you watch out for?