Fast Stomach Ulcers Cure
The most obvious disease associated with H. pylori is peptic ulceration (Fig. 24-4). More than 90 of duodenal ulcers are associated with toxin-producing H. pylori.56 When a patient with a duodenal ulcer does not have H. pylori infection, etiologic factors such as Zollinger-Ellison syndrome or nonsteroidal anti-inflammatory drug (NSAID) use are likely.57 In gastric ulcer, two causes prevail, and many patients will exhibit both. Most gastric ulcers have H. pylori and these can be identified by presence of the bacterium or chronic gastritis. The stomach is also directly exposed to ingested agents such as an NSAID and is more likely than the duodenum to ulcerate in response to these agents. Therefore, in the United States, about 50 of gastric ulcers are not associated with histologic chronic gastritis or H. pylori but are caused by NSAIDs.48 In tropical countries where NSAIDs are less widely used and H. pylori is very common, most gastric ulcers are caused by H. pylori.58 Perhaps because...
Probably the best known stomach disease is peptic ulcer. Peptic ulcers are presumed to be caused by the action of pepsin upon the stomach lining until it becomes eroded, exposing the layers of the cells underneath. Continual secretion of stomach acid irritates the exposed layers of the stomach lining resulting in pain and bleeding. There is no specific cure or treatment for ulcers and the cause or initiating factor in the disease process is not known. People who have peptic ulcers usually are told to avoid stress and are maintained on strict diets. Ulcers may eventually erode completely through a region of the stomach (called a perforation) and cause excessive bleeding. b. Duodenal Ulcer. Duodenal ulcers are ulcers that occur in the duodenum, usually along the initial two inch segment just distal to the stomach. The symptoms for a duodenal ulcer are virtually the same as for a stomach ulcer, but duodenal ulcers are much more common and death due to perforation and...
Occasionally, the exudate or pus accumulation in acute cholecystitis or in perforated peptic ulcers may downward shift to the right lower quadrant of the abdomen, which results in a false reading McBurney point tenderness appears to mimic acute appendicitis. Therefore, the sequence of examination procedure begins from the epigastric area. Step one is to check the antrum, for the first portion of duodenum or for the presence of pneumoperitoneum. The second screening organ is the gallbladder. At this step, check the gallbladder for any inflammatory changes including wall thickness, triple layer, gallstone or fluid accumulation in the pericholecystic area. After screening the epigastric area and liver, right kidney and ascending colon. Along the descending colon downward toward the cecum, attention should be focused on the cecum, ileocecal area, ileum, appendix and adjacent bowel loops. Finally, the probe is shifted downward to the pelvic cavity to check the Douglas pouch, urinary...
By the end of your brief history and physical examination you should have concluded that thrombolytic therapy was not contraindicated. Mr. Saunders does have a history of a bleeding ulcer, but it was approximately a year ago, and does not contraindicate thrombolytic therapy. Indeed, he apparently had thrombolytic therapy with his last heart attack two months ago. Should you decide that thrombolytic therapy is indicated, you will need to check his old chart to see which thrombolytic agent was administered 2 months ago. If it was streptokinase,you would need to use another thrombolytic agent on this occasion because of the possible development of streptokinase antibodies.
The rapid recurrence of H. pylori infection in some areas means that its treatment in impoverished tropical areas needs to be based on objectives that have a likelihood of some success. Goals for control of infection will have to be tempered with the additional need for improved sanitation. Thus, for example, antimicrobial treatment of the majority of the world's population living in tropical, developing areas to eradicate H. pylori for the purpose of preventing cancer would be unrealistic at present. On the other hand, prevention of gastric ulcer and duodenal ulcer recurrence for periods of a year or two might have some utility even where recurrence is high. Ethnic and cultural factors are also worth considering. For example, in Malaysia, prevalence rates among the Malays ranged from 12 to 29 , while the Chinese ranged from 27 to 58 , and Indians were between 49 and 52 .85 H. pylori infection is one of the most common infections in the tropics, significantly associated with peptic...
The answer is e. (Fauci, 14 e, pp 2227-2230.) Primary hyper-parathyroidism is the most common cause of hypercalcemia in the outpatient setting. It is seen more frequently in women than men and is usually due to one parathyroid adenoma (usually in the inferior lobe). Patients often have a history of hypophosphatemia, fatigue, hypertension, depression, peptic ulcer disease, pancreatitis, bone pain, hypercalciuria, and nephrolithiasis from calcium oxalate stones. The most common cause
Most commonly caused by adenomas hyperplasia and malignancy are less common causes. Usually asymptomatic and discovered 011 routine lab check-up. Symptoms result from hypercalcemia and include renal stones, polyuria, bone pain, constipation, nausea, vomiting, lethargy, peptic ulcers, mental status changes, and pancreatitis.
Primary hypersecretion of parathyroid hormone may be caused by an adenoma (vast majority of cases), chief-cell hyperplasia, or carcinoma of the parathyroid glands it is commonly asymptomatic and frequently recognized during routine physical exams. When symptomatic, pcptic ulcer pain, polyuria, polydipsia, constipation, and pancreatitis may be the presenting symptoms. May be associated with multiple endocrine neoplasia (MEN) syndromes I and II.
A 60-year-old patient has epigastric pain and weight loss of a few pounds. The consulting gastroenterologist's evaluation includes upper GI endoscopy, and he discovers a gastric ulcer. Now, the gastroenterologist should c. Peptic ulcer disease 301. The most common location for a gastric ulcer is a. Nearly all duodenal ulcers and most gastric ulcers b. Few peptic ulcers c. Most esophageal ulcers, but not many gastric ulcers d. Nearly all gastric ulcers, but very few duodenal ulcers 310. A 32-year-old man is admitted with a bleeding ulcer. This is his fifth episode of bleeding from gastric ulcers and he also has moderate diarrhea. Each time, his ulcers have been difficult to resolve. Which neoplastic lesion is most likely to be found in this man
Esophageal radiography is used to identify hiatal hernia, varices, strictures, esophageal reflux, and peptic ulcer of the esophagus. Diverticula, chalasia, achalasia, and congenital abnormalities can be diagnosed using barium swallow. This examination can also help in the diagnosis of tumors that put pressure on the esophagus, causing esophageal narrowing and filling defects. Variations from Normal. The upper GI series provides valuable diagnostic information about esophageal strictures, diverticula, varices, and hiatal hernia. Gastric ulcers, inflammatory diseases, tumors, and gastritis can also be diagnosed with this examination. Duodenal ulcers and cancer are identified using UGI. Congenital anomalies and perforation of any visualized structure may be revealed.
A 32-year-old man presents with severe abdominal pain. He describes the pain as sharp and diffuse. He does not drink alcohol or take any medications. He has a past medical history significant for peptic ulcer disease over 5 years ago. The patient has stable vital signs and has no orthostatic changes. You observe the patient to be lying very still on the emergency room stretcher. On physical examination, he has a rigid abdomen and decreased bowel sounds. He has localized left upper quadrant guarding and rebound tenderness. There is referred rebound tenderness on palpation of the right upper quadrant. Rectal examination is FOBT negative. Which of the following is the best method of confirming the diagnosis in this patient
Bethanecol has also been used to stimulate reflex bladder contractions in patients who have had suprasacral spinal-cord injuries (3). The contraindications include peptic ulcer disease, cardiac arrhythmias, bladder or bowel obstruction, bronchial asthma, and hyperthyroidism. In addition, acute circulatory arrest may be caused by intramuscular or intravenous injection. Other side effects include flushing, nausea, vomiting, diarrhea, bronchospasm, headache, salivation, sweating, and visual changes. Overall in several studies, BC has not been demonstrated to cause sustained physiologic bladder contractions in individuals with voiding dysfunction (4-7).
The answer is b. (Berne, 4 e, pp 628-630.) Withdrawal from long-term use of proton pump inhibitors prescribed for peptic ulcer disease may be associated with rebound gastric hypersecretion. Pharmacological suppression of gastric acid secretion can occur when the administered drug binds to a receptor present on the parietal cell or when it antagonizes the hydrogen-potassium-ATPase pump responsible for the active secretion of hydrogen ion into the gastric lumen. At the present time, the most effective antisecretory compounds work by blocking the histamine type-2 (H2) receptor present on the parietal cell or by inhibition of the hydrogen pumps. The latter are the most potent and long-acting, thus increasing the probability of increasing serum gastrin.
Gastrin is a hormone produced and secreted by specialized cells in the stomach. During normal gastric activity, gastrin stimulates the secretion of gastric acid, which aids in digestion and maintenance of the pH environment in the stomach. Gastrin levels can help differentiate patients who have regular peptic ulcer disease from those who may have other conditions. Individuals with regular peptic ulcer disease exhibit normal gastrin levels. Variations from Normal. Gastrin levels in excess of 1000 pg mL are a reliable indicator of Zollinger-Ellison syndrome, a gastrin-producing pancreatic tumor. Highly increased gastrin levels can be supportive of diagnoses such as hyperplasia of the G-cells of the stomach, gastric cancer, or pernicious anemia. Individuals who carry these diagnoses may also present with aggressive peptic ulcer disease. Interfering Circumstances. Peptic ulcer surgery, gastroscopy, and insulin-dependent diabetes may produce a falsely elevated gastrin result. Antacids,...
This happens when blood is lost or destroyed faster than the body can replace it. Blood loss from large wounds, bleeding ulcers, or dysentery can cause anemia. So can malaria, which destroys red blood cells. Not eating enough foods rich in iron can cause anemia or make it worse.
Recurrent abdominal j ain iRAP) occurs in about 10-15 of children between 5 and 15 years of age. Organic causes include diseases of the GI tract such as constipation, lactose intolerance, parasites (Giardia sp), inflammatory bowel disease, and peptic ulcer disease. Pancreatitis and cholelithiasis are pancreatic causes of RAP. Urinary tract infections, abdominal epilepsy, porphyria, sickle cell anemia, and lead poisoning are non-GI causes. In contrast to younger children (
Opioids work best as part of a balanced analgesia regime, utilising regular doses of milder analgesics (e.g. paracetamol) in combination. Typically, if there are no contraindications, a post-operative patient will receive regular paracetamol, a non-steroidal drug (voltarol, feldene, etc.) and opioids, with regular anti-emetic medication. Non-steroidal drugs can reduce the amount of morphine required by a patient, but should be used with caution in patients with a history of stomach ulcers and renal problems.
The glucocorticoids are said to produce peptic ulceration by interfering with tissue repair, decreasing the protection provided by the gastric mucus barrier, and increasing gastric acid and pepsinogen production. Physicians do not all agree that glucocorticoid therapy causes peptic ulcers. However, they do agree that glucocorticoid therapy can hide the symptoms of peptic ulcers so that ulceration or bleeding can occur without warning pains. Some physicians prescribe antacids in hopes of reducing the likelihood of peptic ulcers in patients on glucocorticoid therapy. It
H. pylori grows overlying the antral gastric mucosal cells 40 of healthy individuals and approximately 50 of patients with peptic disease harbor this organism. Although H. pylori does not breach the epithelial barrier, colonization of the antral mucosal layer by this organism is associated with structural alterations of the gastric mucosa and hence with a high prevalence of antral gastritis. Despite the fact that H. pylori does not grow on duodenal mucosa, it is strongly associated with duodenal ulcer, and eradication of the organism in patients with refractory peptic ulcer disease decreases the risk of recurrence. p. 184
The diseases, pathology, or malformation detected by EGD depend on the particular portion of the upper gastrointestinal tract under study. Examination of the esophagus may find abnormalities as varied as tumors, varices, stenosis, hiatal hernia, or esophagitis. In the stomach, the examination may reveal pathology such as gastritis, gastric ulcers, tumors, or bleeding. Examination of the duodenum may reveal diverticula, ulcers, cancers, and duodenal inflammation or malformation.
A patient with a peptic ulcer was admitted to the hospital and a gastric biopsy was performed. The tissue was cultured on chocolate agar incubated in a microaerophilic environment at 37 C for 5 to 7 days. At 5 days of incubation, colonies appeared on the plate and were curved, Gramnegative rods, oxidase-positive. The most likely identity of this organism is
Use of antiplatelet drugs, specifically aspirin and anticoagulants, reduces the risk of stroke in individuals with atrial fibrillation and who have had a previous ischemic stroke.26 Anticoagulation of individuals in normal sinus rhythm with warfarin to levels of international normalized ratio (INR) 2.0-3.0 does not decrease the risk of thrombotic stroke but increases the risk of hemorrhagic stroke.27 Use of clopidogrel shows a modest reduction in stroke risk greater than aspirin. Anticoagulation with warfarin is indicated in all individuals who have atrial fibrillation and who have had a TIA or stroke and who have no contraindications. The range of anticoagulation should be 2.0-3.0 INR. For those individuals in whom warfarin is contraindicated or problematic (history of gastrointestinal bleeding, peptic ulcer disease, frequent falls or seizures, alcohol abuse, unreliable social history, etc.), use of aspirin is an acceptable alternative, because it does reduce the risk of stroke by as...
Questioning during the above procedures reveals that Mr. Saunders has had several heart attacks and several coronary stents placed in the past, and he was hospitalized for a bleeding ulcer about a year ago. He had at least one hospitalization for congestive heart failure. He is allergic to procainamide, but no other drugs. He is currently maintained on a nitroglycerin patch, furosemide 40mg b.i.d., enalapril 10mg b.i.d., Lanoxin 0.125mg every other day, simvastatin 10mg, and one aspirin daily. When asked specifically about clot busting drugs he thinks he was given one with his last heart attack two weeks ago, but is not sure what was the name of the drug.
The answer is d. (Howard, p 457.) Helicobacter pylori was first recognized as a possible cause of gastritis and peptic ulcer by Marshall and Warren in 1984. This organism is readily isolated from gastric biopsies but not from stomach contents. It is similar to Campylobacter species and grows on chocolate agar at 37 C in the same microaerophilic environment suitable for C. jejuni (Campy-Pak or anaerobic jar Gas Pak without the catalyst). H. pylori, however, grows more slowly than C. jejuni, requiring 5 to 7 days incubation. C. jejuni grows optimally at 42 C, not 37 C, as does H. pylori.
The answer is e. (Fauci, 14 e, pp 2227-2230.) Primary hyper-parathyroidism is the most common cause of hypercalcemia in the outpatient setting. It is seen more frequently in women than men and is usually due to one parathyroid adenoma (usually in the inferior lobe). Patients often have a history of hypophosphatemia, fatigue, hypertension, depression, peptic ulcer disease, pancreatitis, bone pain, hypercalciuria, and nephrolithiasis from calcium oxalate stones. The most common cause of hypercalcemia in hospitalized patients is malignancy (i.e., breast, lung, multiple myeloma, head and neck, and renal cell) due to the secretion of parathyroid hormone-related peptide (PTHrp). Patients with familial hypocalciuric hypercalcemia (FHH) have hypocalciuria, a positive family history, and no end organ damage. Other causes of hypercalcemia include sarcoidosis, mycobacteria, milk-alkali syndrome, and medications (i.e., thiazide diuretics). Osteitis fibrosa cystica (replacement by fibrous...
A 36-year-old woman is hospitalized for treatment of a stomach ulcer that has been getting progressively worse over several months. Radiographic studies reveal the site of involvement to be along the greater curvature, approximately 4 cm away from the pyloric sphincter. That night, the ulcer perforates, and there is considerable intra-abdominal bleeding. Surgery reveals that the ulcer has eroded through the stomach wall and has damaged the artery supplying the involved region of the stomach. Which artery was likely involved
The micro-organism Helicobacter pylori is a major cause of gastritis, upper abdominal pain, and gastric and duodenal ulceration. In patients with H. Pylori-associated gastritis, treatment of the infection will ease the symptoms and help heal the inflamed stomach. Chronic gastritis or gastric ulceration puts patients at increased risk of developing cancer of the stomach. and eradicated throughout adulthood (Brenner et al. 1997). Because of the chronic inflammation caused by H. pylori, and the relationship between chronic gastritis and cancer of the stomach, H. pylori is considered carcinogenic. A Japanese study (Uemura et al. 2001) looked at more than 1500 patients who had ulcers of the duodenum or stomach or polyps or hypertrophy of the stomach or dyspepsia (heartburn) without an ulcer. Approximately 80 had evidence of H. pylori infection, and 20 did not. Gastric cancers developed in 36 (2.9 ) of the infected patients and in none of those uninfected. When looked at by specific...
392, The answer is d. (Hardman, pp 909-910.) It is now recognized that infection with H, pylori is a major etiologic factor in peptic ulcer disease. Bismuth salts are bactericidal for many organisms but especially for spirochetes. Colloidal bismuth salts such as bismuth subsalicylate also have a coaling or cytoprotective action. Antimicrobials and GI antisecretory drugs are a so used in combination with bismuth compounds.