doc_clotaire
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A 24-year-old medical student complains of midepigastric pain that she describes as a "dull ache" that is relieved by eating. She has awakened from sleep on several occasions at 2 AM because of severe exacerbation of these symptoms, which are relieved with magnesium hydroxide. She takes frequent acetaminophen for menstrual cramping. Which of the following is the most likely cause of her symptoms?
A. Autonomous gastrin secretion
B. Gram-negative organism
C. Gram-positive organism
D. Prostaglandin inhibition
E. Vagal inhibition
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| Justice
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acetaminophen for menstrual cramping ===> D Prostaglandin inhibition
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| darkhorse
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B.
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| cool doctor
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I dont think that acetamenphine is ulcerogenic
I will go with B
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| tamerbashir
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B
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| hgheith
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I agree, B She most likely has a duodenal ulcer, from what I learned Duodenal pain Decreases with food, and 80-90% duodenal ulcers are caused by H.pylori. (g neg urease +)
Justice I think you were thinking of Nsaids not acetaminophen.
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| doyoudig
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B. Gram-negative organism
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| doc_clotaire
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The answer is : B
Peptic ulcer disease is strongly suggested by chronic midepigastric pain that is severe enough to awaken a patient at night and is relieved by antacids such as magnesium hydroxide. Although the differential diagnosis listed in textbooks for peptic ulcer disease is long, most patients with ulcer symptoms are either taking nonsteroidal anti-inflammatory agents (NSAIDs) or are colonized by the gram-negative organism Helicobacter pylori. This patient is not taking NSAIDs, so H. pylori colonization is the most likely answer. This organism colonizes the mucous layer that lines the stomach and disrupts the integrity of the mucus, predisposing for both chronic gastritis and peptic ulcer disease. Autonomous gastrin secretion (choice A) by a gastrinoma, as occurs in Zollinger-Ellison syndrome, would cause multiple large complicated ulcers, often in association with a secretory diarrhea. Choice C is wrong because H. pylori is gram negative, rather than gram positive. Prostaglandin inhibition (choice D) is the mechanism whereby NSAIDs cause ulcers, but this patient is not taking these drugs. Vagal inhibition (choice E) is actually a treatment for ulcer disease when performed as a vagotomy
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