This paper looks at a case where a 50-year-old woman complains of waking up at night with a bitter taste in her mouth about four times a week for the past two months. It prevents her from sleeping, and she is worried. As a solution to this problem, it is supposed to set symptoms, identify possible diseases in differential and working diagnostics. Then a treatment plan should be developed that includes pharmacotherapy, diagnosis, health education, and preventive care according to the patient’s age. Follow-up after the visit is also indicated.
The established symptom – the taste of bitterness in the mouth – shows that among the possible diseases are duodenal ulcer (from now on referred to as duodenal ulcer), esophageal reflux disease, and pancreatitis. First of all, you need to ask the following questions to the patient: is the indicated symptom accompanied by loss of appetite, pain in the upper abdomen, bloating, indigestion, nausea, flatulence, or burning sensation in the chest. The manifestation of particular symptoms will help make the correct diagnosis, but further clinical examination will be required in any case.
A mandatory measure is the appointment of an ultrasound diagnosis of the intestine. In addition, fibro gastro duodenoscopy (FGDS) is required to make the correct diagnosis. This clinical diagnosis can reveal a duodenal ulcer, which requires immediate treatment. In addition to clinical diagnostics, laboratory diagnostics are also needed. The patient will need to donate blood for alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase tests. This test is usually done to check for liver or bone disease. In addition, alkaline phosphatase is elevated in conditions involving the biliary tract, so this test helps confirm blockage of the biliary tract with stones in the bile duct or pancreatic tumors (Robinson, 2019). In this case, the disturbance of the bile ducts results in a bitter taste in the mouth indicated by the patient. The test results data will also bring the doctor closer to the correct diagnosis of the disease.
Suppose the values obtained from other tests, such as bilirubin, ALT, and AST, are also increased. In that case, the increase in alkaline phosphatase activity in the blood may be associated with liver damage (Robinson, 2019). An increase in alkaline phosphatase activity almost always means damage or involvement in the pathological process of the liver, biliary tract, or bones. According to the results of FGDS, a duodenal ulcer can be detected. In this case, pharmacological treatment is prescribed, aimed at inhibiting the secretion of gastric acid.
The solution to this problem will be the appointment of omeprazole, a drug prescribed to treat stomach ulcers. It is necessary to immediately exclude the possibility of renal or hepatic failure in the patient since this symptom is a contraindication to the use of this drug. In elderly patients, dosage adjustment is not required (Omeprazole). Also, the patient will need to follow a specific diet. The diet includes products that also slightly stimulate the secretory activity of the stomach: cream, fat milk, boiled meat, boiled fish, a soft-boiled egg or in the form of an omelet, white bread of yesterday’s baking, vegetable puree, fruits, and water, free of carbon dioxide. You will need to remove fried foods from the diet, foods containing a lot of table salt, coffee, strong tea, and alcohol (Diet Tips for Stomach Ulcershttps). This diet provides the observance of the correct consistency of food and the balance in terms of proteins, fats, carbohydrates, mineral salts, and vitamins.
The course of treatment with omeprazole with an established diagnosis is from 2 to 4 weeks. During this period, it is necessary to observe a doctor every week to assess recovery dynamics and prevent side effects. It is recommended to keep a diet diary for the physician to evaluate the balance of incoming proteins, fats, carbohydrates, and vitamins. With a positive dynamic of treatment, preventive observation is prescribed 1-2 weeks after recovery and further adherence to the diet throughout the period, depending on the results obtained.
References
Omeprazole. (n.d.) Memorial Sloan Kettering Cancer Center. Web.
Diet Tips for Stomach Ulcershttps. (n.d.) Greatist. Web.
Robinson, J. (2019) What Is an Alkaline Phosphatase Test? WebMD. Web.