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The patient in question is a 64-year-old African American male who presents with epigastric pain that began two days ago and continues to increase. He has a high stress job as a stock broker and was recently served divorce papers. He admits to recent increased alcohol intake in order to manage stressors and currently smokes one and a half packs of cigarettes daily. Findings upon physical examination include a blood pressure of 140/88, a heart rate of 110 bpm, and abdominal pain rated 8/10.  Pain is self-described as steady, sharp through to his back, with a constant burning sensation. Examination of lungs and heart are unremarkable. He does have epigastric and liver tenderness upon palpation. No nystagmus, tremor, or asterixis which would be indicative of withdrawal from alcohol.

What are the possible causes of his abdominal pain?

Gastritis – Inflammation of the stomach lining as seen in gastritis is often caused by 
H. pylori. Without a self-reported history of 
H. pylori treatment, the cause of gastritis may be related to tobacco smoking, alcohol consumption, and/or the use of non-steroidal anti-inflammatory drugs (NSAIDs) or steroids (Azer & Akhondi, 2022).

Peptic Ulcer – Peptic ulcer disease (PUD) most commonly presents with epigastric pain that may be associated with dyspepsia, bloating, abdominal fullness, nausea, and early satiety (Kavitt et al., 2019). The clinician should obtain a clear history of any prior NSAID use and if the patient has had any documented H. pylori infection (Kavitt et al., 2019). An upper endoscopy would be useful in accurately diagnosing this condition.

Acute Pancreatitis – Acute pancreatitis frequently presents with epigastric pain, jaundice, and hyperlipidemia. It can be seen in the setting of alcohol abuse, and liver or gallbladder disease
 (Goolsby & Grubbs, 2019).

GERD – The hallmark symptoms of GERD are heartburn and acid regurgitation; however, patients may also present with chest pain (Maret-Ouda et al., 2020). With regular alcohol consumption, the esophagus may become eroded and lose the lower esophageal sphincter may lose its efficiency in closing. An increased frequency of alcohol intake is directly correlated with the development of GERD (Pan et al., 2019).

Abdominal Aortic Aneurysm – An abdominal aortic aneurysm is a life threatening condition that is most commonly caused by arteriosclerosis. Other risk factors include history of smoking, advanced age, family history, hypertension, and hypercholesterolemia (Goolsby & Grubbs, 2019).  Prominent lateral abdominal pulsations are suggestive of an AAA (Goolsby & Grubbs, 2019).


What further questions would be pertinent in light of the patient’s pattern of drinking?

· Have you ever had a