A 56-year-old man visits the general medical clinic complaining of bloating, acid reflux, and pain during meals. Upon endoscopy, he is diagnosed with a peptic ulcer and further testing reveals the presence of Helicobacter pylori. The patient has a history of depression but is not currently taking any medications. He denies using NSAIDs and has a childhood allergy to penicillin that caused a systemic rash. What is the recommended treatment plan for this patient?
A 32-year-old woman, who is 16 weeks pregnant, has been referred for an opinion by the obstetricians due to recurrent vomiting. Despite treatment with anti-emetics, she has not been able to stop vomiting since the beginning of her pregnancy. As a result, she has lost 5 kg of weight. Nasogastric and nasojejunal feeding were unsuccessful due to recurrent regurgitation of the tubes. Therefore, she has been started on total parenteral nutrition (TPN) and requires supplemental intravenous fluids due to recurrent vomiting. Her blood tests were checked 72 hours after initiating TPN and the results are as follows:
What is the most likely explanation for these results?
An 80-year-old woman presents with melaena, passing dark, black tarry stools for the last 36 hours. She has a medical history of chronic renal failure, angina, and is taking aspirin, isosorbide mononitrate, ramipril, calcium carbonate, alfacalcidol, and erythropoietin. On examination, she is sweaty and clammy with a pulse rate of 102 beats per minute and blood pressure of 102/43 mmHg. Her blood tests show low haemoglobin, high urea and creatinine, and a normal INR. Upper GI endoscopy reveals a gastric ulcer with a visible, non-bleeding vessel and no blood in the stomach. What is the most significant risk factor for mortality based on her clinical history?
A 65-year-old man presents to gastroenterology outpatients to discuss his gastroscopy results. He underwent endoscopy due to a six-week history of dyspeptic symptoms and weight loss, and has a past medical history of osteoarthritis treated with ibuprofen. The gastroscopy report reveals a 3 cm ulcer with flat edges in the gastric antrum, which tested positive for rapid urease (Campylobacter-like organism). He is curious about the impact of Helicobacter pylori eradication therapy and acid suppression on his peptic ulcer disease.
What advice should he be given regarding the effects of Helicobacter pylori eradication therapy and acid suppression on his peptic ulcer disease?
A 40-year-old woman with a history of Crohn’s disease presented to the gastroenterology clinic with complaints of tiredness, loose stools, persistent abdominal pains, bloating, and weight loss of approximately 4kg over the past 8 months. Despite a trial of mebeverine and loperamide, her symptoms persisted. On examination, she appeared pale but otherwise well. Investigations revealed low Hb, high MCV, high platelets, low B12, and high folate levels. Gastroscopy and colonoscopy were normal, but capsule endoscopy showed jejunal strictures and fistulae. The Schilling test showed 1% B12 isotope excretion before and after administration of intrinsic factor. What is the most likely diagnosis?
A 16-year-old female presents with recent onset of yellowing of the skin, myalgia, and fatigue. She has no significant medical history, drinks ten units of alcohol per week, and denies any high-risk behavior. On examination, she has a tender hepatomegaly and clinical jaundice. The following blood tests were obtained in the acute medical unit:
– Hemoglobin: 123 g/L
– White cell count: 10.0 x 10^9/L
– Neutrophils: 7.0 x 10^9/L
– Platelets: 358 x 10^9/L
– Bilirubin: 85 µmol/L
– Aspartate transaminase (AST): 140 U/L
– Alanine aminotransferase (ALT): 180 U/L
– Alkaline phosphatase: 120 U/L
– Albumin: 36 g/L
– Anti-nuclear antibody (ANA): positive
– Anti-Liver Kidney Microsomal-1 antibody (anti-LKM-1): positive
– Anti-mitochondrial antibody: negative
– Hepatitis B surface antigen (HBsAg): negative
– Hepatitis B surface antibody (anti-HBs): positive
– Hepatitis B core antibody (anti-HBc): negative
What is the most likely diagnosis?
An 80-year-old man presents to his GP with complaints of fatigue and epigastric pain that have been progressively worsening over the past 9 months. The pain is diffuse, intermittent, and rated 4 out of 10 in intensity. He reports passing dark stools and appears pale.
During examination, his blood pressure is 120/70 mmHg, and his pulse is 75/min. There is tenderness in the epigastric region. Upper GI endoscopy reveals a mass in the gastric antrum, and a biopsy of the mass shows infiltrates of lymphoid cells. A CT scan of the chest and abdomen shows normal lymph nodes.
What is the most appropriate management for this patient?
A 27-year-old primigravida woman presents to the hospital at 18 weeks gestation with increasing confusion. Her husband reports that she has been experiencing severe vomiting for the past 4 weeks, making it difficult for her to eat but she has been able to consume small amounts of fluids.
The patient has no significant medical history and is not taking any regular medications.
Upon examination, she is afebrile with a pulse of 110 bpm and blood pressure of 105/70 mmHg. She is alert but disoriented to time and place. Cranial nerve examination reveals bilateral VIth nerve palsy and multi-directional nystagmus. Peripheral neurological examination shows MRC grade 4/5 power in both lower limbs, absent lower limb jerks, bilateral loss of distal vibration sense, and downgoing plantar responses.
Blood tests are ordered and show the following results:
Hb 118 g/l Na+ 133 mmol/l
Platelets 360 * 109/l K+ 2.9 mmol/l
WBC 12.5 * 109/l Urea 9.1 mmol/l
Neuts 10.3 * 109/l Creatinine 115 µmol/l
Lymphs 1.8 * 109/l CRP 18 mg/l
Eosin 0.02 * 109/l Glucose 3.2 mmol/l
What is the most appropriate course of treatment for this patient?
A 42-year-old male presents to the gastroenterology clinic after being referred by his primary care physician. The patient reported experiencing persistent loose stool and mild fatigue. He is a non-smoker and his alcohol intake is within the recommended weekly limit. During the physical examination, the GP noted mild jaundice and mild hepatomegaly, but no other signs of chronic liver disease. The patient underwent a non-invasive liver screen (NILS) prior to being referred to the clinic, which revealed abnormal results. The patient’s laboratory results showed an elevated bilirubin level, high ALP, and positive anti-nuclear antibodies. The abdominal ultrasound showed mild hepatomegaly. Based on these findings, what is the most likely diagnosis?
A 44-year-old man presents to the hospital after experiencing a first episode of syncope. His wife witnessed him suddenly becoming very pale and collapsing to the floor with loss of consciousness for a few seconds, but he immediately regained orientation upon waking up. The patient reports progressively worsening exertional dyspnoea and fatigue over the last few months. He also has been experiencing severe joint pains that have spread to involve other joints. On examination, he is dyspnoeic on minimal exertion, has an irregularly irregular pulse, and peripheral oedema. Investigations reveal abnormal glucose levels, widespread T-wave inversion on ECG, and cardiomegaly with pulmonary oedema on CXR. Which further investigation would be the most useful in confirming the diagnosis?