4 Clinical case discussion （上海交大仁济临床医学院《医学专业英语》课件PPT）.ppt

Comprehension questions (II) Which of the following is not true of H.pylori infection: A. It is more common in developing counties It is associated with the development of gastric lymphoma It is believed to be the cause of nonulcer dyspepsia The route of transmission is believed to be fecal – oral It is believed to be a cause of most duodenal and gastric ulcer * Answer --- C While H.pylori is clearly linked to gastric and duodenal ulcers, and probably to gastric carcinoma and lymphoma, it is unclear whether it is more common in patients with nonulcer dyspepsia, or whether treatment in those patients reduces symptoms. * Comprehension questions (III) A 45-year-old male was brought to the emergency room after vomiting bright red blood. He has a blood pressure of 88/46 mmHg and heart rate of 120 bpm. Which of the following is the best next step? IV fluid resuscitation and preparation for a transfusion Administration of a proton pump inhibitor Guaiac test the stool Treatment for H.pyroli * Answer --- A This patient is hemodynamically unstable with hypotension and tachycardia as a consequence of the acute blood loss. Volume resuscitation, immediately with crystalloid or colloid solution, followed by blood transfusion, if necessary, is the initial step to prevent irreversible shock and death. Later, after stabilization, acid suppression and H.pylori treatment might be useful to heal an ulcer, if one is present. * Comprehension questions (IV) Which one of the following patients should be promptly referred for endoscopy? A 65-year-old man with a new onset of epigastric pain and weight loss A 32-year-old whose symptoms are not relieved with ranitidine A 29-year-old H. pylori- positive patient with dyspeptic symptoms A 49-year-old women with intermittent right upper quadrant pain following meals * Answer --- A Patient “A” has a red flag: he is older than 45 years of age with new onset symptoms. Patient “B” may benefit from the reassuranc