 |  Concepts needs sorting out...help.
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| Author | 16 Posts |
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I hope you help me on some of these issues.
1)In G6PD hemolytic anaemia.....there's Heinz body right??OK I read somewhere else(Kaplan) in Thalasemia alpha major(only 1 normal coding gene for aplha chains) there is aggregation of 4 beta chains forming HbH.....and then forms Heinz body!!!!!Are the above 2 heinz bodies the same....in that case do we see Bite cells in Thallasemia A(like how we see too in G6PD anemia???)
2)Its mentioned in BRS Pathology that peptic ulcer diseases are not precursor to Stomack cancer....is that true???I always though a chronic peptic ulcer disease does eventually turn malignant??
3)Assuming BRS is right and peptic ulcer disease does not cause cancer......however its known H.Pylori can cause peptic ulcer.....so why isn't the H.pylori in peptic ulcer disease causing the cancer there then??
4)H.Pylori infections can cause chronic gastritis......while autoimmune chronic gastritis is easier to differentiate....how does one differentiate Chronic gastritis due to H.Pylori from peptic ulcer just on the basis of histoy and examination?and if its not possible the only way of differentiating the both and need to do gastroscopy to look for ulcer in peptic ulcer disease(as urea breath test can be positive for both)....is there any other investigation??
5)Whats the treatment for chronic gastritis due to H.Pylori???
Thanks for your input.
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| Ahab
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Not familiar with the heinz body you are referring to in alpha thallasemeia, HbH is incompatible with life (causes hydrops fetalis), HbBart (3alpha chains missing) is the clinical picture of alpha thallasemiacs, mild symptoms in those with one or two alpha chains missing)
2. Chronic peptic ulcer disease is not premalignant, unless it is caused by h. pylori (a carcinogen). In that case it is still the bacteria which is the carcinogen
3. See above (not all chronic peptic ulcers are caused by h. pylori)
4. Not sure you can to be honest, I think you treat initially with h2 blockers or PPIs and if symptoms persist move onto tx for H. Pylori (in the absence of confirmatory tests which are very expensive)
A urea breath test will not show up chronic ulcer disease in the absence of h. pylori
5. Triple therapy consisting of a variation of a acid blocker and two antibiotics, I.e. Omeprazole, metronidazole and amoxicillin
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| Malaysian
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Thanks Ahab......I think its Bart Hb which is incompatible with life(hydrops fetalis) and HbH is seen when 3 of the apha thal genes are made in active.....well thats what Kaplan says atleast.......I think they must have amde a mistake then regarding the heinz bodies in association with HbH???
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| mani
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there are other combination as well that can be used for eradication therapy like omeprazole, clarithromycin & amoxicillin; omeprazole, MTZ & clarithromycin
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| dariush
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also Bismuth compounds are very commonly used for H.P. (+) PU. such as "Bismuth acylsalicylate" or "Bismuth Ranitidin". and ofcourse the good old friend Metro.
and Chronic Gast. (H.P.(-) is Not Urease (+) !! by no means.
Ahab, what do you mean by expensive confim. test (4) ? it is actually not that complicated. when i was in the GI dep. i used "Breath urea test" for every second pt. coming to the endoscopy and taking Biopsy doesnt cost that much, right ??!!
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| Ahab
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"dariush" wrote:
Ahab, what do you mean by expensive confim. test (4) ? it is actually not that complicated. when i was in the GI dep. i used "Breath urea test" for every second pt. coming to the endoscopy and taking Biopsy doesnt cost that much, right ??!!
Maybe not in a society where your insurance will pay for it, what did you bill the companies for? As i understand it those breath kits dont come cheap. Over here (ireland) in a medical system where cost/benefit takes not quite precedent but certainly has an impact sending a patient to an outpatients dept and having them wait hours to be seen etc. when the diagnosis is almost certain is seen as a waste of resources and is reserved only for those high risk groups (older with chronic symptoms). This is in a family practice setting mind, and if you have health insurance you can run the test anyway but to what benefit?
Also I made a mistake earlier, HbH is B4 tetramers while HbBart is gamma4 tetramers (i.e. in utero)
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| Malaysian
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thanks all for the input.Atleast its clearer now for me in grasping this concept.
The H.Pylori treatment mentioned above is only for chronic gastyritis or for peptic ulcer disease or can be used for both due to H.Pylori???
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| mani
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it is called eradication therapy, used to eradicate H pylori in any case
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| Malaysian
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OK thanx and correct me if I'm wrong....Chronic gastritis due to H.pylori does not show any ulcer but only inflmation??Or it too shows ulcers like peptic ulcer disease.
There was this question posted by someone stating it to be NMBE q does anyone know the answer for sure.
The Q goes like this(or to this effect atleast)
A pt. with restrictive lung disease will have a compensatory breathing for his condition causing changes of what sort to his resp. rate and tidal volume??
the option for both the parameters(resp. rate and tidal volume) are separate and include:
1)increase
2)decrease
3)normal
Needless to be said answer is unknown!!
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| Alina T
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I'd say
-decreased tidal volume
-increased respiratory rate
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| dariush
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i think both increase! let's not forget what dec. in Rest. diseases is the TLC and VC but not V(t) i.e. the pt. might try to reach a higher V(t) (deeper breath) which is higher than that of normal people but still less than his VC.
i hope i was clear.
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| Alina T
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Dariush,
restrictive pulm disease means decrease in pulm compliance. that means that the alveoli do not expand enough on inspiration, thus letting less air to get in on a REGULAR inspiration and the same little air gets out . this equals decreased tidal volume, right?
it sounds clear enough for me.....if i'm missing something, please point out.
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| mani
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i agree with Alina T. if u look at flow volume curve of a normal person and a person with restrictive lung disaease, this point will be clear
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| mani
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Malaysian, there will be no ulcers in the chronic gastritis
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| Malaysian
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Ok thanks guys.....I wasn't sure if it was decreased or normal tidal volume with increased resp. rate.But now I'll pay special emphasis on the curve when I do my revision.
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| dariush
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Alina T, you're right. i thought of a sort of a compensation but what i didnt consider was the Restriction itself :oops:
thanx
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