Bloating And Frequent Belching

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Bloating And Frequent Belching Essay

QUESTION 1

  1. A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that has persisted for 2 weeks. He describes the pain as burning, non-radiating and is worse after meals. He denies nausea, vomiting, weight loss or obvious bleeding. He admits to bloating and frequent belching.Bloating And Frequent Belching Essay

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PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.

Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain

Family Hx-non contributary

Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use, vaping or unprotected sexual encounters.

Breath test in the office revealed + urease.

The healthcare provider suspects the client has peptic ulcer disease.

1 of 2 Questions:

What factors may have contributed to the development of PUD?
1 points
QUESTION 2

  1. A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that has persisted for 2 weeks. He describes the pain as burning, non-radiating and is worse after meals. He denies nausea, vomiting, weight loss or obvious bleeding. He admits to bloating and frequent belching.
    PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections. Bloating And Frequent Belching Essay
    Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain
    Family Hx-non contributary
    Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use, vaping or unprotected sexual encounters.
    Breath test in the office revealed + urease.
    The healthcare provider suspects the client has peptic ulcer disease.
    2 of 2 Questions:
    How do these factors contribute to the formation of peptic ulcers?

1 points
QUESTION 3

  1. A 36-year-old morbidly obese female comes to the office with a chief complaint of “burning in my chest and a funny taste in my mouth”. The symptoms have been present for years but patient states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5 weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night when she is lying down and has had to sleep with 2 pillows. She says she has started coughing at night which has been interfering with her sleep. She denies palpitations, shortness of breath, or nausea.Bloating And Frequent Belching Essay

PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2)

Family history-non contributary

Medications-amlodipine 10 mg po qd, dicyclomine 20 mg po, ibuprofen 600 mg po q 6 hr prn

Social hx- 15 pack/year history of smoking, occasional alcohol use, denies vaping

The health care provider diagnoses the patient with gastroesophageal reflux disease (GERD).

Question:

The client asks the APRN what causes GERD. What is the APRN’s best response?

QUESTION 4

  1. A 34-year-old construction worker presents to his Primary Care Provider (PCP) with a chief complaint of passing foul smelling dark, tarry stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed.Bloating And Frequent Belching Essay

Question:

What factors can contribute to an upper GI bleed?

1 points
QUESTION 5

  1. A 64-year-old steel worker presents to his Primary Care Provider (PCP) with a chief complaint of passing bright red blood when he had a bowel movement that morning. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some left lower quadrant pain for several weeks but described it as “coming and going”. He says he has had a fever and abdominal cramps that have worsened this morning. The likely diagnosis is lower GI bleed secondary to diverticulitis.

Question:

What can cause diverticulitis in the lower GI tract?Bloating And Frequent Belching Essay

1 points
QUESTION 6

  1. A 48-year-old man presents to his gastroenterologist for increasing abdominal girth and increasing jaundice. He has a long history of alcoholic cirrhosis and has multiple admissions for encephalopathy and GI bleeding from esophageal varices. He has been diagnosed with portal hypertension and tells the APRN that he was told he had chronic, non-curable cirrhosis.

Question:

How does cirrhosis cause portal hypertension?

1 points
QUESTION 7

  1. A 48-year-old man presents to his gastroenterologist for increasing abdominal girth and increasing jaundice. He has a long history of alcoholic cirrhosis and has multiple admissions for encephalopathy and GI bleeding from esophageal varices. He has been diagnosed with portal hypertension. The increased abdominal girth has been progressive, and he says it is getting hard to breathe. The APRN reviews his last laboratory data and notes that the total protein is 4.6 gm/dl and the albumin is 2.9 g/dl. Upon exam, he has icteric sclera, jaundice, and abdominal spider angiomas. There is a significant fluid wave when percussed. The APRN tells the patient that he has ascites. Bloating And Frequent Belching Essay
    Question:
    Discuss how ascites develops as a result of portal hypertension.

UESTION 8

  1. A 45-year-old man with known alcoholic cirrhosis, portal hypertension, and ascites is brought to the ED by his family due to increasing confusion. The family states that he had been stumbling for several days but had not fallen. The family also noted that he had been “flapping his hands” as well. Labs in the ED reveal Hgb 9.4 g/dl, Hct 28.0 %, ammonia (NH3) level is 159 μmol/L. The APRN informs the family that the patient has developed hepatic encephalopathy (HE).

Question:

Explain how hepatic encephalopathy develops in patients with cirrhosis of the liver.

1 points
QUESTION 9

  1. A 65-year-old man with a history of atrial fibrillation presents to his PCP’s office 2 months after suffering from a myocardial infarction.  He declined anticoagulation due to fear he would bleed to death. He has had sudden-onset, moderately severe diffuse abdominal pain that began 18 hours ago. He has been vomiting, and he has had several episodes of diarrhea, the last of which was bloody. He has a fever of 100.9 ˚ F. CBC reveals WBC of 15,000/mm3.Bloating And Frequent Belching Essay

Question:

What is the most likely mechanism behind his current symptoms?

1 points
QUESTION 10

  1. A 46-year-old Caucasian female presents to the PCP’s office with a chief complaint of severe, intermittent right upper quadrant pain for the last 3 days. The pain is described as sharp and has occurred after eating french fries and cheeseburgers and radiates to her right shoulder. She has had a few episodes of vomiting “green stuff”. States had fever and chills last night which precipitated her trip to the office. She also had some dark orange urine, but she thought she was dehydrated.

Physical exam: slightly obese female with icteric sclera as well as generalized jaundice. Temp 101˚F, pulse 108, respirations 18. Abdominal exam revealed rounded abdomen with slightly hypoactive bowel sounds. + rebound tenderness on palpation of right upper quadrant. No tenderness or rebound in epigastrium or other quadrants. Labs demonstrate elevated WBC, elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Serum bilirubin (indirect) 2.5 mg/dl. Abdominal ultrasound demonstrated enlarged gall bladder, dilated common bile duct and multiple stones in the bile duct. The APRN diagnoses the patient with acute cholecystitis and refers her to the ED for further treatment.Bloating And Frequent Belching Essay

Question 1 of 2:

Describe how gallstones are formed and why they caused the symptoms that the patient presented with.

1 points
QUESTION 11

  1. A 46-year-old Caucasian female presents to the PCP’s office with a chief complaint of severe, intermittent right upper quadrant pain for the last 3 days. The pain is described as sharp and has occurred after eating french fries and cheeseburgers and radiates to her right shoulder. She has had a few episodes of vomiting “green stuff”. States had fever and chills last night which precipitated her trip to the office. She also had some dark orange urine, but she thought she was dehydrated.

Physical exam: slightly obese female with icteric sclera as well as generalized jaundice. Temp 101˚F, pulse 108, respirations 18. Abdominal exam revealed rounded abdomen with slightly hypoactive bowel sounds. + rebound tenderness on palpation of right upper quadrant. No tenderness or rebound in epigastrium or other quadrants. Labs demonstrate elevated WBC, elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Serum bilirubin (indirect) 2.5 mg/dl. Abdominal ultrasound demonstrated enlarged gall bladder, dilated common bile duct and multiple stones in the bile duct. The APRN diagnoses the patient with acute cholecystitis and refers her to the ED for further treatment.Bloating And Frequent Belching Essay

Question 2 of 2:

Explain how the patient became jaundiced.

1 points
QUESTION 12

  1. Ruth is a 49-year-old office worker who presents to the clinic with a chief complaint of abdominal pain x 2 days. The pain has significantly increased over the past 6 hours and is now accompanied by nausea and vomiting. The pain is described as “sharp and boring” in mid epigastrum and radiates to the back. Ruth admits to a long history of alcohol use, and often drinks up to a fifth of vodka every day.

Physical Exam:

Temp 102.2F, BP 90/60, respirations 22. Pulse Oximetry 92% on room air.

General: thin, pale white female in obvious pain and leaning forward. Moving around on exam table and unable to sit quietly.

CV-tachycardic. RRR without gallops, rubs, clicks or murmurs

Resp-decreased breath sounds in both bases with poor inspiratory effort

Abd- epigastric guarding with tenderness. No rebound tenderness. Negative Cullen’s and + Turner’s signs observed. Hypoactive bowel sounds x 2 upper quadrants, and no bowel sounds heard in both lower quadrants.Bloating And Frequent Belching Essay

The APRN makes a tentative diagnosis of acute pancreatitis based on history and physical exam and has the patient transferred to the ER where laboratory and radiographic exams reveal acute pancreatitis.

Question:

Explain how pancreatitis develops and the role alcohol played in this patient’s case.

1 points
QUESTION 13

  1. A 23-year-old bisexual man with a history of intravenous drug abuse presents to the clinic with a chief complaint of fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, and dark urine. He says the symptoms started about a month ago and have gotten steadily worse. He admits to reusing needles and had unprotected sexual relations with a man “a couple months ago”.

PMH-noncontributory.

Social/family history-works occasionally as a night clerk in a hotel. Parents without illnesses. Admits to bisexual sexual relations and intravenous heroin use. He has refused drug rehabilitation. 3 year/pack history of tobacco but denies vaping.

Physical exam unremarkable except for palpable liver edge 2 fingerbreadths below costal margin. No ascites or jaundice appreciated.Bloating And Frequent Belching Essay

The APRN suspects the patient has Hepatitis B given the strong history of risk factors. She orders a hepatitis panel which was positive for acute Hepatitis B.

Question:

What are the important hepatitis markers that indicated the patient had acute hepatitis B?

1 points
QUESTION 14

  1. Hannah is a 19-year-old college sophomore who came to Student Health with a chief complaint of lower abdominal pain. She says the pain has been present for 2 months and she has had multiple episodes of diarrhea alternating with constipation, and anorexia. She says she has lost about 10 pounds in these 2 months without dieting. The abdominal pain has gotten worse in the last 2 hours, but she thought she had “the GI bug” like other students at her Synagogue had.

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Physical exam-noncontributory except for the abdomen which was lightly distended with no visible masses. Normoactive BS x 4. Diffuse tenderness throughout but increased pain on deep palpation LUQ & LLQ. Slight guarding but no rebound tenderness or rigidity.Bloating And Frequent Belching Essay

Rectal-tight anal sphincter and patient grimacing in pain during exam. Slightly + guaiac stool.

Based on her history and current symptoms, the APN arranges for a consult with a gastroenterologist who diagnoses Hannah with ulcerative colitis (UC).

Question:

How does ulcerative colitis develop in a susceptible person?

1 points
QUESTION 15

  1. A 64-year-old woman with long standing coronary artery disease presents to the clinic with lower extremity swelling, abdominal distension, and shortness of breath. Patient states she has a 30-pound weight gain in 6 weeks and is now requiring 3 pillows to sleep.

On physical exam the patient is a well-developed, well-nourished female exhibiting signs of respiratory distress with use of accessory muscles. Blood pressure 150/80, pulse 105, respirations 28 and labored. Body weight 89 kg. HEENT was unremarkable. Cardiac exam had an S1, S2 and S3 without S4 or murmur. Respiratory exam was positive for bilateral rales 1/2 up both lung fields. Abdomen was enlarged with a positive fluid wave. Lower extremities were remarkable for 3+ pitting edema.Bloating And Frequent Belching Essay

Laboratory data was significant for an increase in K+ from 3.4 mmol/l to 6.1 mmol/l in 2 weeks, BUN increased from 18 mg/dl to 104 mg/dl, and creatinine increased from 0.8 mg/dl to 6.9 mg/dl.

CXR revealed congestive heart failure. The APRN calls the cardiologist on call who admits the patient to the hospital and orders a nephrology consult.

She was diagnosed with exacerbation of congestive heart failure (CHF) and acute kidney injury (AKI).

Question:

What type of acute kidney injury does the patient have and what factors contributed to this diagnosis?

1 points
QUESTION 16

  1. The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, related hormones, and glomerular filtration rate. Bloating And Frequent Belching Essay
    Question:
    What would be the most important concept of glomerular filtration rate that the APRN should address?

1 points
QUESTION 17

  1. The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, glomerular filtration rate, autoregulation, and related hormone factors regulating renal blood flow

Question:

What would be the most important concept of autoregulation that the APRN should address?

1 points
QUESTION 18

  1. The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, glomerular filtration rate, autoregulation, and related hormone factors regulating renal blood flow

Question:

What would be the most important concept of hormonal regulation that the APRN should address?Bloating And Frequent Belching Essay

1 points
QUESTION 19

  1. A 28-year-old female comes to the clinic with a chief complaint of right flank pain, urinary frequency, and foul-smelling urine. The symptoms have been present for 3 days but this morning, the patient states she had a fever of 101 F and thought she should get it checked out. Physical exam noncontributory with the exception of right costovertebral angle (CVA) tenderness upon percussion. Urine dipstick shows + blood, + bacteria and + white blood cells. Renal ultrasound reveals right staghorn renal calculus and the patient was diagnosed with acute pyelonephritis.

Question:

How does a renal calculi calculus contribute to acute pyelonephritis?

1 points
QUESTION 20

  1. Mr. Kent is a 45-year-old African American male with a history of Type 2 diabetes, hypertension, and hyperlipidemia. His renal function has slowly decreased over the past 4 years and his nephrologist has told him that his GFR has decreased to 15cc ml/min and will soon need renal dialysis for chronic renal failure.Bloating And Frequent Belching Essay

Question:

How does chronic renal failure develop?
1 points

Causes of Excessive Belching
by Susha Cheriyedath, M.Sc.
Although belching is a physiological process, there are various conditions that may lead to or cause excessive belching or burping, usually conditions that involve the stomach, duodenum, gallbladder, and esophagus. It may also be caused by lifestyle and dietary factors, such as the type of food eaten and the method of eating.

Digestive system diagram

It is important to note that belching is a normal part of human behavior and is needed to rid the stomach of excess gas that is swallowed when eating or produced during the process of digestion. However, excessive belching can become problematic if it occurs on a very frequent basis and is paired with other symptoms, such as abdominal pain.

Physiological causes
Lifestyle and dietary factors may contribute to some cases of excessive belching. This may include swallowing air when eating or drinking or the consumption of certain food and drink, such as cabbage, cauliflower, broccoli, beans, and carbonated beverages.Bloating And Frequent Belching Essay

It is a commonly believed myth that most cases of excessive belching are associated with swallowing air or certain foods and drinks. However, this is not true as most cases of excessive belching are, in fact, related to diseases of the gastrointestinal tract. These are widely grouped together as pathological causes and discussed in more detail in the following sections.

Hiatal hernia
A hiatal hernia is a condition that involves the extension of a portion of the stomach through the esophageal hiatus into the chest cavity. This alters the passage of food into the stomach and disrupts the mechanisms that are needed to prevent the backflow of stomach acid into the esophagus. In this case, periods of burping tend to come and go, according to the changing position of the stomach.

Small intestine bacterial overgrowth
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Similar to the bacterial infection of the stomach, the small intestine can also sometimes be affected by bacterial overgrowth that may lead to excessive belching. Small intestine bacterial overgrowth (SIBO) usually affects the duodenum, which can lead to the production of gas and burping.

Infections of the stomach
Bacterial infections of the stomach, such as Helicobacter pylori (H. pylori) can lead to the production and release of gas from the stomach. As such, it may contribute to burping to some extent, although the volume of gas is thought to be slight. However, the bacterial infection also leads to increase the acidity of the stomach, which can also contribute to the accumulation of gas and, hence, burping.Bloating And Frequent Belching Essay

Food intolerance
Indigestion of or intolerances to certain foods can also contribute to excessive belching. This is because the nutrients remain in the gut for consumption by bacteria, which produces gas as a byproduct. Common intolerances that may be associated with frequent burping include lactose intolerance, gluten intolerance, fructose malabsorption, and sorbitol malabsorption.

Insufficiency of the pancreas
The pancreas is an important organ for the production of digestive enzymes that are needed for the chemical breakdown of foods in the gastrointestinal tract. Insufficiency of the pancreas, due to bile duct stones, pancreatitis, or pancreatic cancer, can lead to an inability to digest food adequately, leading to food intolerances and malabsorption. As a result of the bacterial consumption of the nutrients, excessive belching may occur.

Belching is physiological venting of excessive gastric air. Excessive and bothersome belching is a common symptom, which is often seen in patients with functional dyspepsia and gastroesophageal reflux disease. Other symptoms are usually predominant. However, a small group of patients complain of isolated excessive belching, with a frequency of several belches per minute. In these patients, the eructated air does not originate from the stomach but is sucked or injected in the esophagus from the pharynx and expelled immediately afterward in oral direction. This behavior is called supragastric belching because the air does not originate from the stomach and does not reach the stomach either. Excessive belching can be treated by speech therapy or behavior therapy. The term aerophagia should be reserved for those patients where there is evidence that they swallow air too frequently and in too large quantities. These patients have excessive amounts of intestinal gas visualized on a plain abdominal radiogram and their primary symptoms are bloating and abdominal distension and they belch only to a lesser degree. Aerophagia and excessive supragastric belching are thus two distinct disorders. Bloating And Frequent Belching Essay