vi - vicissitude

[ArchivalUser]

A 30 yrs woman with no history of any rectal bleeding and 3 month hist. or moderate abd. pain improved shortly after eating has midepigastric tendrness. BP: 110/70 and temp. 36.4 deg.; pulse 80/min. Labs: hem. 12; leukocyte count 8000; positive H. pylori antibody assay. Next step in management?
1. Ranitidine therapy (T)
2. ciprofloxacin T
3. Amoxicillin, omeprazole (O), clarithromycin T
4. HIDA scan
5. O, magnesium hydroxide, metoclopramide T

[ArchivalUser]

3. triple therapy

[ArchivalUser]

- in real scenario biliary colic should be always ruled out wih usg but this case 3, looks like a choice because hida is done only if usg has failed. it mean it is a question of duodenal ulcer but could be gastric also investigation is done for seeing snd biopsying the ulcer as well as for definitive diagnosis of h pylori. positive anti pylori antibody assay is not sufficient for starting the rx for asyptomatic ulcer but this case is syptomatic.

there is small but substantial chance of missing gastric cancer, though 30 is not a time usually but occurs in some case.


anyway in this question i have to choose 3 ,--amoxycillin/omeprezole and clarithromycin

3 is my answer

[ArchivalUser]

vicissitude,
I really apprecitae your questions.
is it possible to number the vignettes? It would be easier to follwo up.
thanks

[ArchivalUser]

3.
duodenal ulcer cos of h.pylori tx is triple therapy(including 2 antibiotics)

[ArchivalUser]

This cas is not suggestive of Biliary colic bc "pain improved shortly after eating " while pain start after eating in BC bc inc bile duct tone. & The pain is in epigastric area, not RUQ.