Health Assessment

Stomach Pain

Carnel C. Jackson, DNP, RN, FNP-BC

Case Study

Chief Complaint

“My stomach has been hurting on and off for months, but now I can’t hold anything down for the past 5 days.”

Patient Profile

Name: Dylan Scelsi

Age: 24 years old

Gender: male

History of Presenting Illness

D.S. is a 24-year-old man who presented with a 5-day history of progressively worsening abdominal pain and nausea.* The abdominal pain was described as a burning sensation localized to the epigastric region.* It was persistent but exacerbated by meals and relieved slightly with antacids. He also reported intermittent nausea, occasional bloating, and a decreased appetite for 5 days.* There was no reported hematemesis, though he reports dysgeusia and dyspepsia.

Dylan returned from a 2-week trip to Ecuador that was about 1 month ago. He did report that he consumed local food and water.* He denied any known ingestion of contaminated food but notes that his symptoms began shortly after returning. He has no prior history of similar symptoms, peptic ulcer disease, or significant gastrointestinal issues. He did report a 5–10-pound weight loss due to his inability to eat due to pain and nausea.*

Past Medical History

Seasonal allergies

Medications

  • Loratadine: 10 mg by mouth daily
  • Calcium Carbonate: 500 mg 1 tablet by mouth as needed every 4 hours

Social History

  • Insta-shopper
  • Mission trip to Ecuador 1 month ago
  • Lives in a dormitory
  • Alcohol use: social only (1-2x per month)
  • Tobacco smoke: none
  • Illicit drug use: none

Family History

  • Mother: hypertension
  • Father: transient ischemia attack, coronary artery disease
  • Maternal grandmother: gastric cancer
  • Maternal grandfather: hypertension, hyperlipidemia, basal cell carcinoma
  • Paternal grandparents: unknown

Review of Systems

  • Constitutional: Denies chills, fever, fatigue, weight gain. Endorsed an unintentional 5 pound weight loss in 4 weeks.*
  • HEENT: Denies postnasal drip, sore throat, hearing impairment. Denies blurred vision.
  • Respiratory: Denies shortness of breath, cough, and wheezing.
  • Cardiovascular: Denies chest pain and pedal edema.
  • Gastrointestinal: Endorses abdominal pain, tenderness, nausea and emesis. Denies constipation, diarrhea, melena, hematochezia.* Early satiety.*
  • Derm: Denies breaks in the skin, lesions and rashes.
  • Neurological: Denies headaches, dizziness, headaches, and tremors.
  • Hematologic: Denies easy bruising.

Physical Assessment

Vital Signs

  • Blood pressure: 110/64 mm Hg
  • Heart rate: 102 bpm
  • Respiratory rate: 18 bpm
  • Temperature: 99.5℉
  • Oxygen saturation: 99% on room air

General Survey

  • General appearance: Alert, oriented, slender male.
  • HEENT: Dry mucous membranes, poor skin turgor,* pale conjunctiva.*
  • Cardiovascular: Normal rhythm without murmurs, normal s1 and s2.
  • Respirations: Clear to auscultation bilaterally.
  • Abdomen: Active bowel sounds x4, mild tenderness to palpation in the epigastric region without guarding,* Mcburney’s negative,* Rovsing’s negative.*
  • Derm: Without abrasion or ulceration, color is appropriate for ethnicity.
  • Neurological: No focal deficits, no signs of confusion or cognitive impairment.

Diagnostic Testing

  • Comprehensive Metabolic Panel:
Table 1. Laboratory results for Mr. Scelsi

Substance

Value

Normal Range
Glucose (Fasting) 76 70-99 mg/dL (fasting)
Sodium (Na) 135 136-144 mEq/L
Potassium (K) 3.4 3.4-5.2 mEq/L
Chloride (Cl) 112 96-106 mmol/L
BUN 18 7-20 mg/dL
Creatinine 1.24 0.8-1.4 mg/dL
Calcium (Ca) 8.9 8.5-10.9 mg/dL
Protein (total) 7.1 6.3-7.9 g/dL
Glomerular filtration rate 69 90-120 mL/min/1.73m2
Urine Protein 76* < 30 mg/dL
H. Pylori Breath Test Positive* -Standard: Negative
Bacterial and Parasitic Stool Panel ~ pending -Standard: Negative
  • H. pylori breath test: positive.
  • Bacterial and parasitic stool studies pending.

Assessment

Most likely diagnosis: Gastritis secondary to H. pylori.

Treatment Plan

  1. Gastroenterology referral – will consider endoscopy.
  2. Bismuth sub-citrate 420 mg by mouth 4 times daily x 14 days.
  3. Metronidazole 375 mg by mouth 4 times daily x 14 days.
  4. Tetracycline 375 mg by mouth 4 times daily x 14 days.
  5. Omeprazole 20 mg by mouth 2 times daily x 14 days.
  6. Patient education.

Review Questions

Click the arrow to expand the section and view the correct answers.

  1. In a patient presenting with nausea and emesis, which objective findings support dehydration? Select all that apply.
    1. Xerostomia
    2. Polyuria
    3. Hyperhidrosis
    4. Hypersalivation
    5. Poor skin turgor
Answer:

A), E) Xerostomia and poor skin turgor. Feedback: Xerostomia and poor skin turgor are clinical symptoms of dehydration.

  1. In a patient that presents with acute-on-chronic epigastric abdominal pain, which of the following clinical signs are most consistent with iron-deficient anemia? Select all that apply.
    1. Fatigue
    2. Melena
    3. Menorrhagia
    4. Brittle nails
Answer:

A), B) Fatigue and melena. Feedback: Fatigue, melena and brittle nails are all signs of a chronic iron deficiency diagnosis that is consistent with an epigastric cause. Menorrhagia is described as prolonged or excessive bleeding during the menstrual cycle.

  1. For this patient, which of the following is the greatest risk factor for H. pylori-induced gastritis?
    1. Alcohol consumption
    2. Living condition
    3. Work
    4. Recent travel to developing countries
Answer:

D) Recent travel to developing countries. Feedback: Patients that are living in a developing country or have recently traveled for greater than 7 days are at an increased risk for H. pylori. Helicobacter pylori is highly prevalent in Ecuador.

  1. Which of the following objective findings is most characteristic of gastritis?
    1. Abdominal distention
    2. Epigastric pain/discomfort
    3. Nausea
    4. Fatigue
Answer:

B) Epigastric pain/discomfort. Feedback: Abdominal distention is not typically seen in patients with gastritis. Nausea and fatigue are not exam findings. The most appropriate answer is epigastric pain/discomfort with and without palpation.

  1. Patients with untreated H. pylori infections are at an increased risk for which of the following? Select all that apply
    1. Chronic inflammation of the stomach
    2. Ulcers
    3. Stomach pain/discomfort
    4. Esophageal adenocarcinoma
Answer:

A), B), C) Chronic inflammation of the stomach, ulcers, and stomach pain/discomfort. Feedback: Untreated H. pylori infections may lead to chronic inflammation, ulcers, and gastric adenocarcinoma. H. pylori does not increase the risk of esophageal adenocarcinoma, but does increase the risk of gastric malignancies.

  1. Patients may report that abdominal pain and symptoms intensify:
    1. Within 15 minutes of meals
    2. In the middle of the night when the stomach is empty
    3. When they drink small sips of water
    4. Laying on their left side
Answer:

B) In the middle of the night when the stomach is empty. Feedback: Patients typically report that symptoms are worse on an empty stomach due to the burning sensation that is associated with ulcers. Typically, meals help relieve symptoms of H. pylori and small sips of water also relieve symptoms. Lying on the left side helps prevent gastric acid from touching the lower part of the esophagus.

Clinical Pearls

* All areas with asterisks are highlighted for a patient with this chief complaint.

Helicobacter pylori – Gastritis:

  • A gram-negative bacterium that can live in stomach acid. Over time this may lead to gastritis. If this goes untreated, this can lead to peptic ulcer disease, gastric cancer, and/or lymphoma.

Clinical presentation:

  • Dull, gnawing pain
  • Worse when the stomach is empty
  • Other common symptoms: nausea, bloating, early satiety, dyspepsia

Physical examination:

  • Mild tenderness to palpation over the epigastric region
  • Pale conjunctiva, poor skin turgor, brittle nails
  • Other complications: melena, unintentional weight loss due to early satiety

Diagnostics:

  • Helicobacter pylori serology, cannot confirm past or current infection
  • Stool antigen test
  • Urea breath test – most accurate, no PPI use 2 weeks prior

MUST:

  • Must always confirm eradication

Treatment:

  • Bismuth quadruple therapy (14 days):
    • PPI BID
    • Bismuth subsalicylate QID
    • Metronidazole TID
    • Tetracycline QID

* There are newer alternatives that may be cost prohibitive.

References

Godman, H. (2022, June). What’s the best sleep position to combat heartburn? Harvard Health Publishing. https://www.health.harvard.edu/diseases-and-conditions/whats-the-best-sleep-position-to-combat-heartburn

Johns Hopkins Medicine. (n.d.). Helicobacter pylori. https://www.hopkinsmedicine.org/health/conditions-and-diseases/helicobacter-pylori

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Be Prepared for Your Nurse Practitioner Clinical Readiness Exam Copyright © 2026 by Elizabeth Heavey, Renee Biedlingmaier, Colleen Burgoyne and Carnel C. Jackson is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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