drk1980
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A 28-year-old man living in a small rural township is admitted to the hospital because of gastrointestinal bleeding. On admission the patient is pale and has orthostatic hypotension. Hemoglobin concentration is 8 g/dL. His condition is stabilized. Emergent upper endoscopy shows a visible gastric vessel, which is treated appropriately.
Specific additional history should be obtained regarding which of the following?
A) Consumption of alcoholic beverages
B) Family history of cancer
C) Source of drinking water
D) Travel history
E) Use of tobacco products
Which of the following is the most appropriate laboratory study?
A) Antibodies for Helicobacter pylori
B) Vitamin B12 (cyanocobalamin) concentration
C) Ferritin concentration
D) Gastrin concentration
E) Iron concentration
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| dr.wad
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E
D
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| nadiabarati
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E smoking is a risk factor for peptic ulcer
A 90% of peptic ulcers are related to H. pylori
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| star1
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Tobacco smoking, alcohol and the use of steriod do not cause Peptic ulcer disease ,
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| Justice
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Colleagues,
how about (C) & (A)?
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| Justice
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Just to help my colleagues understand reasons of my choices:
http://query.nytimes.com/gst/fullpage.html?sec=he...
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| Justice
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There is another link to that:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD...
J Am Acad Nurse Pract. 2005 Jul;17(7):283-9. Related Articles, Links
Click here to read
Rural health alert: Helicobacter pylori in well water.
Reavis C.
School of Nursing, Georgia Southern University, Statesboro, GA 30460-8158, USA.
PURPOSE: This exploratory research project is an epidemiological study to determine in a specified population of farmworkers in Southeast Georgia the following: (a) the prevalence rate of gastritis, (b) related cofactors contributing to gastritis with or without a positive diagnosis of Helicobacter pylori (HP), (c) relationship of contaminated drinking water to gastritis, and (d) relative risk of acquiring gastritis from HP-contaminated drinking water. DATA SOURCES: Data were collected from five common water sources for 147 farmworkers in rural Southeast Georgia. Farmworkers were given a survey to identify cofactors related to HP gastritis. Water samples were taken from four common well water sources (experimental group) and one control well, analyzed for HP, and associated through nonparametric categorical data analysis to the survey items to discover possible relationships. CONCLUSIONS: Analysis of data using nonparametric regression showed a weak positive relationship (p= 0.07) between symptoms of gastritis and the HP-contaminated water. Risk analysis demonstrated that farmworkers who drank water contaminated with HP were 2.6 times more likely to have symptoms of gastritis. IMPLICATIONS FOR PRACTICE: This research established a positive relationship between well water contaminated with HP and signs and symptoms of gastritis. Nurse practitioners (NPs) working with populations who drink well water and have the signs and symptoms or positive diagnosis of HP should have a high degree of suspicion that the well water may be a source of HP infection. In addition to treating the patient for HP gastritis, NPs may utilize this research to plan other interventions that decrease the incidence of HP-related illnesses such as recommending well water treatment.
Publication Types:
* Research Support, N.I.H., Extramural
* Research Support, Non-U.S. Gov't
* Research Support, U.S. Gov't, P.H.S.
PMID: 15982249 [PubMed - indexed for MEDLINE]
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| muna
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A ,C
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| radonc
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E. Tobacco.
A. Serologic testing for H. pylori.
Tobacco retards ulcer healing, so pts are advised to stop smoking.
Moderate alcohol intake has not been shown to be associated with ulcers. Alcohol has been linked to gastritis.
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| Justice
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radonc wrote:
E. Tobacco.
A. Serologic testing for H. pylori.
Tobacco retards ulcer healing, so pts are advised to stop smoking.
I think we are discussing what caused the ulcer, not retards its healing, which will be afterwards....
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| star1
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This is most likely Zollinger Ellison Syndrome,
B) Family history of cancer
D) Gastrin concentration
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| Justice
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star1 wrote:
This is most likely Zollinger Ellison Syndrome,
B) Family history of cancer
D) Gastrin concentration
IN ZE syndrome the ulcers are numerous and many of them are located in duodenum and as low as in ileum... This is very pathognomonic for ZES... In addition, in ZES the ulcers are quite shallow, so no vessels could be seen...
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| nadiabarati
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NOTHING in favor of ZE!!!
Justice, I'm sure that cigarrete smoking is a risk factor for peptic ulcer. You can check it out. %100 sure.
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| star1
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Kaplan notes 2006, peptic ulcer disease , its mentioned that tobacco smoking, alcohol and steriod do not cause ulcer by themselves...
I choose ZE syndrome ..
i). mean age of presentation of ZE is 40 + but about 7% ZE cancer occur in patient of less than 20 year age.
ii) they cause GI bleeding
iii) We are seeing ulcer bed with the help of endoscope. and By the way can u see all the ulcer with endoscope at one time????
Comments plz
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| Justice
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iii) We are seeing ulcer bed with the help of endoscope. and By the way can u see all the ulcer with endoscope at one time????
Comments plz
[/quote]
Yes, you can... You just rotate the scope to see what's around...
I agree that smoking isn's the major factror... For PUD, the Kap notes says that 70% of gastric ulcers are due to H. pylori... All others - NSAID, tobaco, alkohol, steroids... Whereas I don't see this Pt having ZES, (he does not have diarrhea, etc), H. pylori is the stronges factor one could find... And drinking well water (a rural place) is known to have H. pylori...
I wish my colleagues never had a Q like that on their exams...
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| star1
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| radonc
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This is not ZE syndrome.
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