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حالة سريرية

الوصف الكامل Background
A 57-year-old woman has had a 2-cm gastric ulcer at the midpoint of the lesser curvature of the stomach for 3 months. The ulcer was first diagnosed endoscopically because of a history of epigastric pain and one episode of vomiting with a trace of blood. At the first endoscopy multiple biopsies were read as negative for cancer, and also negative for the presence of H. pylori. She was treated with dietary measures and H2 blockers. On re-endoscopy 6 weeks later, the ulcer was essentially unchanged. Biopsies were again negative for malignancy and for H. pylori. Serologic tests and breath tests for H. pylori were also negative. Her H2 blockers were replaced by omeprazole, and sucralfate and misoprostol were added to her therapeutic regimen. At the current endoscopy, 6 weeks after the second one, the ulcer was slightly smaller but still present. Biopsies were not taken because she was gagging and the procedure had to be terminated. Which of the following is the most appropriate treatment at this time?
a- Addition of anticholinergics to her current regimen
b- Antrectomy that includes excision of the ulcer
c- Empiric antibiotics to eradicate H. pylori
d- More of the same for another 6 weeks
e- Vagotomy and pyloroplasty
by


d- More of the same for another 6 weeks

لأنو ما في شي جديد. والأوميبرازول بكفي بظن.

KMG's picture
KMG
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Quote:
More of the same for another 6 weeks
a.m.a's picture
a.m.a
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d

Fouad's picture
Fouad
بعد التخرج


c

dr.tabban's picture
dr.tabban


d

the best's picture
the best
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confused له زعلتوني منكم :

The correct answer is B. Her trial of medical therapy has already gone beyond the usual recommended time, and the ulcer can be declared to be unlikely to heal with similar continued efforts. Furthermore, the possibility of cancer now looms large. Negative biopsies are reassuring, but they are not ironclad guarantees of benignity. Sampling errors can hide the cancer. The ulcer has to come out, along with the antrum.
Anticholinergics (choice A) are contraindicated for gastric ulcers, as they aggravate gastric stasis.
H. pylori has to be eradicated (choice C) when it is there, but not when it is not. Negative tests in this case are not histological samples that could have missed the target but biochemical tests that detect the high production of urease by the H. pylori.
More of the same (choice D) can already be predicted to fail.
Vagotomy and pyloroplasty (choice E) is the wrong operation. High acid secretion is not the problem (although acid is needed to produce the ulcer), and resection of the ulcer is imperative to reliably rule out malignancy
qusei


محاولة خجولة
D

Inspector's picture
Inspector
السنة السادسة


d??

SINA's picture
SINA
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بالعكس مشاركتك هنا انسبكتر كتيرررررررررررررررررر حلوة وممتازة واشجعك على الدخول Razz

qusei


كنت متوقع B والله كجواب تاني لأنو الزلمة ختيار.

KMG's picture
KMG
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hmmm

Quote:
Furthermore, the possibility of cancer now looms large. Negative biopsies are reassuring, but they are not ironclad guarantees of benignity. Sampling errors can hide the cancer

interesting, thanx

SINA's picture
SINA
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Embarrased Embarrased Embarrased
يا أخي أنا ما بحب الجراحة.....

Fouad's picture
Fouad
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Quote:

يا أخي أنا ما بحب الجراحة.....

me too

انا حاكمت الحالة بناء على قصة شخصية ,كان معي قرحة وعولجت بppi لمدة طويلة وبعدين شفيت لكن الفرق انو القرحة عندي عفجية اما مريضنا هون قرحة معدية وهي اكثر قابلية للتسرطن بالاضافة للشيء المهم التاني وهو العمر

a.m.a's picture
a.m.a
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Quote:
القرحة عندي عفجية اما مريضنا هون قرحة معدية وهي اكثر قابلية للتسرطن بالاضافة للشيء المهم التاني وهو العمر

القرحة العفجية بالغالبية المطلقة سليمة عكس المعدية Razz

qusei
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