Patient L., 36, the driver, was taken to hospital with complaints of worsening health, dizziness, tinnitus, palpitations, shortness of breathing, the emergence of black liquid stool, which arose after an episode of vomiting coffee grounds. In the history of the patient - recurrent deterioration, the appearance of pain in the epigastrium, local, very intense, associated with the intaking of spicy, sour, hard food and hunger; heartburn, sour taste in the mouth. Pain subsides after intaking milk, antacids and after vomiting.
Objective: the patient is in consciousness, adequate. Skin is pale, moist and clean. Tongue is clean and moist. Arterial blood pressure: 95/65 mm Hg.. Pulse: 110/min. The abdomen is painful and resistent in epigastric region, from right side. Symptom Mendel is positive. The lower edge of the liver are not palpable. Gall bladder`s symptoms are negative. Pain in the projection points and areas of the pancreas is not defined. Hourly urine output: 40 ml / min.
Fibergastroduodenoscopy: ulcerative mucosal defect on the small curvature of the stomach with signs of bleeding that occurred. Ultrasound organs of abdominal cavity: pathological changes were detected. CBC: Hb 90 g/l, Er. 2,7 • 1012/l, Leuk. 11,0 • 109/l, Pl 400 • 109/l. Biochemical investigation of blood: total protein: 72 g/l, urea: 8.1 mmol/l, ALT: 0,6 mmol/l, AST: 0,45 mmol/l. Analysis of urine amylase: 64 U/l.
1. Put diagnosis.
2. Prescribe proper treatment.
Materials for self-control:
А. The questions for self-control:
1. Name the main etiological factors of PUD.
2. Name the non-invasive and invasive methods for diagnosis of H.pylori infection.
3. What are the main clinical symptoms of PUD?
4. Make the plan of additional investigation of the patient with PUD.
5. What are the first-line therapy and second-line therapy H.pylori eradication
6. Name the main drugs for the short-term treatment of PUD.
Tests for the determining of basis knowledge
Tests of the 1st level.
1. The aetiological factor of peptic ulcer are, except:
A. Klebsiella
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