Day 6 Internal medicine 4 course 2nd sem. Chronic gastritis. Diseases of the gallbladder and biliary tract Functional dyspepsia. Peptic ulcer and other ulcers of the stomach and duodenum.

A 53-year-old woman complains of weight loss up to 10 kg within the last 2 years, liquid foul-smelling stool two times a day that poorly washes off the toilet, periodic bouts of nausea, girdle pain in the upper abdomen. Objectively: pain in Gubergrits zone (on the right from navel) and Mayo-Robson’s point. Biochemical blood analysis: glucose - 3,2 mmol/l, bilirubin - 16,5 micromole/l, crude protein - 56,4 g/l. Urine diastase - 426 g/h/l. D-xylose test (oral administration of 25 g of dxylose) after 5 hours reveals 3 g of xylose in urine. The most likely diagnosis is:

After having the flu, a 39-year-old male patient with a history of Addison’s disease developed a condition manifested by weakness, depression, nausea, vomiting, diarrhea, hypoglycemia. AP- 75/50 mm Hg. Blood test results: low corticosterone and cortisol, 13-oxycorticosteroids, 17-oxycorticosteroids levels. What condition developed in the patient?

A 45-year-old patient complains of pain in the epigastric region, left subcostal area, abdominal distension, diarrhea, loss of weight. He has been suffering from this condition for 5 years. Objectively: tongue is moist with white coating near the root; deep palpation of abdomen reveals slight pain in the epigastric region and МауоRobson’s point. Liver is painless and protrudes 1 cm from the costal arch. Spleen cannot be palpated. What disease can be primarily suspected?

A 42-year-old man was delivered to a surgical in-patient department with complaints of icteric skin, pain in the right subcostal area. Biochemical blood analysis: total bilirubin - 140 mcmol/l, direct bilirubin – 112 mcmol/l. On US: choledoch duct - 1,4 cm, a concrement is detected in the distal area. Gallbladder is 40 cm, no concrements. What treatment tactics should be chosen?

A 54-year-old patient complains of weakness, jaundice, itching skin. Disease onset was 1,5 months ago: fever up to 39 o C appeared at first, with progressive jaundice developed 2 weeks later. On hospitalisation jaundice was severely progressed. Liver cannot be palpated. Gallbladder is enlarged and painless. Blood bilirubin is 190 micromole/l (accounting for direct bilirubin). Stool is acholic. What is the most likely jaundice genesis in this patient?

A 60-year-old woman, mother of 6 children, developed a sudden onset of upper abdominal pain radiating to the back, accompanied by nausea, vomiting, fever and chills. Subsequently, she noticed yellow discoloration of her sclera and skin. On physical examination the patient was found to be febrile with temp of 38, 9 oC, along with right upper quadrant tenderness. The most likely diagnosis is:

A 35-year-old patient complains of heartburn, sour eructation, burning, compressing retrosternal pain and pain along the esophagus rising during forward bending of body. The patient hasn’t been examined, takes Almagel on his own initiative, claims to feel better after its taking. Make a provisional diagnosis:

What juice should be included in a complex drug and dietary therapy for patients with gastric ulcer or duodenal ulcer and increased gastric juice acidity in order to accelerate the ulcer healing?

4 hours after having meals a patient with signs of malnutrition and steatorrhea experiences stomach pain, especially above navel and to the left of it. Diarrheas take turns with constipation lasting up to 3-5 days. Palpation reveals moderate painfulness in the choledochopancreatic region. The amylase rate in blood is stable. X-ray reveals some calcifications located above navel. What is the most likely diagnosis?

A 46-year-old male patient complains of periodic epigastric pain that occurs at night. Objectively: HR- 70/min, AP- 125/75 mm Hg, tenderness in the epigastric region is present. EGD confirms duodenal ulcer of 0,6 cm in diameter. Test for H. Pylori is positive. Which of the given antisecretory drugs will be a compulsory element of the treatment regimen?

A 64-year-old patient has been hospitalised with complaints of progressive jaundice that developed over 3 weeks ago without pain syndrome, general weakness, loss of appetite. Objectively: temperature is 36,8 o C , heart rate is 78/min, abdomen is soft and painless, peritoneum irritation symptoms are not detected, palpation reveals sharply enlarged tense gallbladder. What disease can be characterised with these symptoms?

A 28-year-old patient has been hospitalized for the pain in the epigastric region. He has a 10-year history of duodenal ulcer (DU). Recently, the pain character has changed: it became permanent, persistent, irradiating to the back. There are general weakness, dizziness, fatigue. The patient has put off weight. Objectively: HR68/min, AP – 120/80 mm Hg. What is most likely cause of deterioration?

A 56-year-old physician attends your office the day after an upper endoscopy performed for dyspeptic symptoms. He has already read the report, which mentions diffusely thickened gastric folds. He is very worried and asks about the potential differential diagnosis.

Which of the following is not a differential diagnosis for thickened gastric folds?

A 56-year-old man attends for review of his Barrett's esophagus (BE). He was diagnosed 8 years ago with short-segment non dysplastic Barrett's esophagus, (NDBE), which was confirmed 12 months later. He had endoscopies 5 and 2 years ago, which continued to show NDBE.

He asks, of 1000 patients in my scenario, how many develop esophageal adenocarcinoma (EAC) each year?

A 27-year-old woman with idiopathic gastroparesis diagnosed 6 months ago is hospitalized with dehydration from persistent nausea and vomiting. She is now unable to keep down solid foods and has limited tolerance of liquids. She has lost 20 lb in the past month (baseline weight 132 lb, height 5′ 6″). Prior endoscopy with gastric biopsy was normal. An upper GI barium study showed delayed gastric transit with normal duodenal transit and no obstruction. Her recent abdominal X-ray is normal.

What method should be used to provide nutrition support?