李蓉《内科学精品教学》12.peptic ulcer.pptVIP

Case study Case 1: A 27-year-old man has a 3-month history of intermittent burning epigastric pain that is made worse by fasting and improves with meals. Antacids provide temporary relief. He is otherwise healthy and has no other symptoms. His only medication is occasional acetaminophen for knee discomfort. Physical examination discloses only mild epigastric tenderness to palpation; vital signs are normal. Which of the following diagnostic studies should be done next? A) Abdominal ultrasonography B) Serologic testing for H. pylori C) Upper endoscopy D) Upper gastrointestinal barium study Case 2: A 65-year-old woman was recently discharged from the hospital after treatment of upper gastrointestinal bleeding secondary to a duodenal ulcer. While hospitalized, she underwent upper endoscopy, and antral biopsy specimens showed H. pylori. The patient was treated with appropriate antibiotics and a proton pump inhibitor. When seen for a follow-up visit 6 weeks after completing her medical regimen, she is asymptomatic, and her hemoglobin is normal. Which of the following diagnostic studies should be done next? A) Repeat upper endoscopy with antral biopsies B) Hydrogen breath test C) 13C-urea breath test D) Serologic testing for H. pylori E) No additional studies are indicated Case 3: A 59-year-old man has a 3-month history of epigastric discomfort and nausea without weight loss, melena, or vomiting. Over-the-counter H2-receptor antagonists have been ineffective. The patient is otherwise healthy and takes no other medications. Physical examination reveals mild epigastric tenderness to palpation. Upper endoscopy shows a 1-cm duodenal ulcer, and antral biopsy specimens demonstrate chronic gastritis and H. pylori infection. Which of the following is the most appropriate therapy for this patient? A) A proton pump inhibitor for 2 months B) An H2-receptor antagonist for 2 months C) A proton pump inhibitor and amoxicillin for 2 weeks D) A proton pump inhibit