Case 13 – Over the Counter

Case #13: Over the Counter
Author: Michael Gottlieb, MD
Peer Reviewer: Jenny Lu, MD

A 71 year old female with a past medical history of hypertension, peptic ulcer disease, osteoarthritis, and chronic low back pain presented to the ED with abdominal pain for the past day. The abdominal pain began early yesterday morning and was epigastric, sudden-onset, constant, sharp, 10/10, non-radiating and not improved/worsened/associated with any other factors. Review of systems also revealed increased bilateral knee and back pain for which she had been self-treating with a two or three over-the-counter (OTC) pain reliever pills every hour for the past two days. Physical exam is significant for abdominal tenderness worst in the epigastrium without rebound tenderness or guarding. Rectal exam revealed occult blood.

Vitals: Temp: 98.2, HR: 98, RR: 12, BP: 132/94, O2 sat: 97% on RA

What is the most likely etiology of this patient’s presentation?
What other clinical symptoms might you expect to see with this patient?
What is the initial management for this patient?
What are some common drug interactions with NSAIDs?
What is the disposition for these patients?


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