Task №1.

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 intakingof spicy, sour,hardfood and hunger; heartburn, sour taste in the mouth.Painsubsides afterintaking milk, antacids and after vomiting.

Objective: the patient is inconsciousness,adequate. Skinis pale, moist and clean. Tongueis clean and moist.Arterial blood pressure: 95/65 mm Hg.. Pulse: 110/min. The abdomen is painful andresistentin epigastric region,from right side. Symptom Mendelis positive. The lower edge of the liverarenot palpable.Gall bladder`ssymptomsarenegative. 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 smallcurvature 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. Biochemicalinvestigation 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. Prescribeproper 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:

1. Klebsiella

2. non-steroidal anti-inflammotory drugs

3. Helicobacter pylori

4. smoking

2.. Helicobacter pylori produce enzyme:

A. lipase

B. somatostatin

C. lactase

D. urease

3. The best diagnostic test for Helicobacter pylori is:

A. histology

B. serology

C. urea breath test

D. rapid urease test

4. Abdominal pain in the patients with the gastric or duodenal ulcer is characterized by, except:

A. relationship to food

B. localization to the epigastrium

C. permanent

D. episodic occurrence

5. The cornerstone of therapy for peptic ulcers is:

A. prokinetic effect

B. enhance mucosal defence

C. inhibit acid secretion

D. Helicobacter pylori eradication

6. The most powerful inhibitors of gastric secretion are:

A. antacids

B. proton pump inhibitors

C. H2-receptors antagonists drugs

D. M-cholin-receptor antagonists drugs

7. Primary (first-line) H. pylori eradication therapy include, except:

A. clarithromycin

B. omeprazole

C. bitsmuth

D. amoxicillin

Recommended literature for students:

А. Main:

1. Davidson’s Principles and Practice of Medicine, 2006, P. 534-539, 581-591.

Б. Additional:

Methodic chart made by docent Berko G.K.