digestive case study

As Dr. Lorraine is listening to Mr. Volpe's complaints she automatically visualizes the organs in the epigastric region that are the potential source of his problems. Where is the epigastric region and what organs associated with digestion are located in that area?

The epigastric region is the upper middle region of the 9 abdominopelvic regions and contains the stomach, parts of the duodenum, gallbladder, and pancreas. Also contains part of the liver.

The structures in the epigastric region share a common nerve supply. Can you name the specific cranial nerve that serves this region and the part of the nervous system to which it belongs?

The Vagus nerve, located in the parasympathetic division of the autonomic nervous system serves the epigastric region and controls digestion.

Dr. Lorraine suspects a peptic ulcer with bacteria as the cause. Mr. Volpe asks, "What do the bacteria have to do with the ulcer?" Dr. Lorraine tells him that the H. pylori increases stomach acid secretion and, at the same time, breaks down the lining of your stomach and duodenum. What is the source and normal function of acid in the stomach and what regulates its production?

The source of acid in the stomach is coming from parietal cells. A normal function of acid in the stomach is used to kill certain organisms that are ingested with food. Also, acid can help activate enzymes (like pepsinogen to pepsin) as well. Gastrin (as well as histamine and ACh from the vagus nerve) regulates the production of acid in the stomach.

The medication Pepcid® that Mr. Volpe took for partial relief of his dyspepsia is called an H2 (histamine) receptor antagonist, or H2 blocker. That means it prevents histamine from binding to its receptor. What is the normal function of histamine in the stomach and how might this help Mr. Volpe's hyperacidity problem?

The normal function of histamine in the stomach is to trigger the release of stomach acid for digestion. The H2 blockers inhibiting histamine means less stomach acid would be produced thus helping his hyperacidity problem.

Why is Mr. Volpe's dyspepsia relieved by food, and aggravated 2-4 hours after a meal?

that the food raises the pH in the stomach, making the acidity lower and less harsh on the ulcer. Once the food is out of the stomach, the pH goes back down and is harsh on the ulcer, thus causing pain.