CASE STUDY 26 - Oscar Perez

Oscar Perez, age 38, presents with abdominal pain that began 24 hours ago. Mr. Perez describes his pain as sharp and constant, centered in the mid-epigastric region and over into the upper right quadrant of his abdomen. He denies ever having this severe pain before but has had abdominal pain on and off for the past several months. Tylenol for abdominal pain seems to help a little. Aspirin makes his stomach hurt worse with a kind of “burning” pain. He admits to having stomach bloating after meals, heartburn, belching, and nausea.
Mr. Perez works as a carpenter and is currently self-employed. His family history is negative for cancer, but his father has non–insulin-dependent diabetes, hypertension, and heart disease. Mr. Perez smokes approximately half a pack of cigarettes per day and has been smoking since the age of 17 years. His alcohol consumption is beer and bourbon, which he consumes mostly on the weekends. He states that he usually drinks until he “gets drunk.” He has been drinking since the age of 17 years but has increased his consumption for the past 10 years. Mr. Perez admits the use of illegal intravenous drugs in the past but has been drug free for 12 years.
On physical examination, Mr. Perez is noted to be in no acute distress, has normal vital signs, normal hemoglobin and hematocrit, negative urinalysis for bacterial infection, and active bowel sounds in all four abdominal quadrants. On palpation of the abdomen, Mr. Perez complains of pain in the upper epigastric region and right upper quadrant. The physician orders more laboratory blood studies, including liver enzymes, amylase, and a white blood count and differential, and orders gastric radiography (upper GI series) and endoscopy. Mr. Perez is started on Zantac, 150 mg by mouth (PO) in the morning and evening (twice daily [bid]), and is scheduled for a follow-up visit in 1 week. He is given instructions to call or come in earlier if his pain increases or he notes blood with vomitus or stool.

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