What diagnostic testing should be recommended

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Reference no: EM133948273

Question

A 75-year-old male presents to the family practice clinic for routine follow-up visit. He reports, for the past three weeks, he has experienced increasing episodes of post-prandial heartburn with some regurgitation and dysphagia. He states, "My acid reflux is getting worse and my medicine isn't working anymore! I get burning pain in the middle of my chest about an hour after I eat. Sometimes, I have a hard time getting food down, it gets stuck behind my breastbone. This hasn't happened before!" He also reports beginning OTC antacids since his last clinic visit and using pillows at night to "prop up", but is awakened most nights with this pain.

PMHx: HTN X 15 yrs, GERD X 7 yrs, alcoholic cirrhosis X 2 yrs, hiatal hernia. Family Hx: non-contributory.

Medications: Verapamil SR 120mg po QD, HCTZ 25 mg po QD, famotidine 20mg po Q HS.

Social Hx: widowed, lives alone, daughter nearby and checks on him; retired coach; (+) caffeine intake 5 cups/day; (+) alcohol- heavy in past, now 6 beers/wk; smoking 55 pack-year history, now 3/4 ppd.

Physical Exam and V/S: BP 155/90, P 75 (regular), R 18, T 97.90 , Ht 68 in., Wt 195 lb, BMI 29.64 kg/m2

General: pleasant, talkative, dressed appropriately, looks stated age, no apparent distress.

HEENT: PERRLA, EOMI, oropharynx clear, pink/moist mucous membranes.

Lungs: CTA Heart: regular rhythm/rate, no additional heart sounds.

Abdomen: normoactive BS, soft, nontender, nondistended, no hepatosplenomegaly, no bruits.

Genitourinary/Rectum: no hemorrhoids/rectal masses, brown stool without occult blood.

Answer the following questions based on the information provided:

1. Which clinical information suggest worsening symptoms of GERD in this patient?

2. Identify all those factors that may be contributing to the patient's symptoms.

3. What diagnostic testing should be recommended for this patient?

4. What would be the possible expected findings and serious future complications of GERD for this patient?

Reference no: EM133948273

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