1. Describe the principal, advantage and limitation of every diagnostic test to detect H.pylori.(1, 2) Test Principal Advantage Limitation Rapid urease test In the presence of H. pylori urease, urea is metabolized to ammonia and bicarbonate resulting in an increase in pH, which changes the color of a pH-sensitive indicator. Tests for active H. pylori infection; >90% sensitivity and specificity. Results are rapid (within 24 hours), and test is less expensive than histology or culture. Withhold H2RAs and PPIs 1 to 2 weeks before testing and antibiotics and bismuth salts 4 weeks before testing to reduce the risk of false-negatives. Histology • A tissue sample, called biopsy, that is taken from the stomach lining is the most accurate way to tell …show more content…
Perform a literature search and assess current information on the efficacy of various agents in the prevention of NSAIDS-induced ulcers. (3, 4) i. Misoprostol - Early studies in normal volunteers shows marked reduction in incidence of gastrointestinal ulcer in patients receiving NSAIDs with misoprostol compared to those who received NSAIDs + placebo. - RCT in patient suffering from osteoarthritis and rheumatoid arthritis revealed misoprostol is better than sucralfate and ranitidine. - A meta analysis of RCT showed misoprostol better that H2 receptor antagonist. - Recent meta-analysis revealed that co-therapy with misoprostol reduced the incidence of duodenal ulcer by 53% and gastric ulcer by 74%. - another study has shown that half-dose misoprostol (200 µg twice daily) does not prevent recurrent ulcer complications in high-risk patients with arthritis and a history of ulcer bleeding. ii. Proton pump inhibitors - Two RCTs performed in osteoarthritis and rheumatoid arthritis patient with ulcers >3 mm in diameter or >10 mm erosions comparing omeprazole with placebo, misoprostol and ranitidine. Omeprazole co-therapy resulted in significant reduction total number of NSAID related ulcer. - Two studies reported that omeprazole is superior to ranitidine and …show more content…
Frank L. Lanza M, FACG 1,2 , Francis K.L. Chan , MD, FRCP, FACG 3, EMMQ, MD, FACG 4, Parameters atP, Gastroenterology CotACo. Guidelines for Prevention of NSAID-Related Ulcer Complications nature publishing group. 2009. 4. Chan FKL. Primer: Managing NSAID-induced Ulcer Complications - Balancing Gastrointestinal and Cardiovascular Risks2006. Available from: http://www.medscape.com/viewarticle/545617_6. 5. Oscar D. Guillamondegui M, Oliver L. Gunter J, MD, John A. Bonadies M, Jay E. Coates D, Stanley J. Kurek D, Marc A. De Moya M, et al. Stress Ulcer Prophylaxis2008. Available from: https://www.east.org/education/practice-management-guidelines/stress-ulcer-prophylaxis. 6. Rohan C Clarke M, Emmanuel Gbadehan M, Uzodinma R Dim M, Rachael M Ferraro D. Stress-Induced Gastritis Treatment & Management2015. Available from: http://emedicine.medscape.com/article/176319-medication. 7. Ryan J. Daley P. Prevention of stress ulceration: Current trends in critical care Critical Care Medicine October 2004 Volume 32(Issue 10 ). 8. Faisy C, Guerot E, Diehl J-L, Iftimovici E, Fagon J-Y. Clinically significant gastrointestinal bleeding in critically ill patients with and without stress-ulcer prophylaxis. Intensive Care Medicine.
Having the black box around the warning means that an adverse reaction to the drug may lead to death or serious injury.2 Lewis also had low urine output post-surgery another reason ketorolac should not have been used due to ketorolac’s potentiation of renal toxicity.1 With that, this drug was used with no observed cautionary measures conducted. Lewis never received a hands on assessment to determine the severity of his symptoms, checked for side effects and/or pain. Instead, Lewis’ occurring symptoms were dismissed and unqualified personnel (nurses) diagnosed his symptoms as “gas pains” with the assumption that all patients are the same, a concept known as anchoring, being fixed in a
My preceptor and I discussed both the dangers of this class of medications as well as their usefulness. We also discussed the fact that there is new research to
Instead, your doctor looks at the test results as well as your medical history and symptoms to come up with the diagnosis. This may also entail ruling out other medical conditions such as irritable bowel disease or gluten sensitivity. Since a diet low in inflammatory foods is one treatment for leaky gut, your doctor may even recommend you begin this treatment for LGS if the condition is suspected. If you improve with dietary treatment, it could be a positive sign that helps your doctor make the final diagnosis of leaky gut
The purpose of this experiment is to determine the identity of an unknown active ingredient in over the counter NSAIDS. An NSAID is also called a nonsteroidal anti-inflammatory drug. These drugs are used for pain management and reducing inflammation without containing steroids. NSAIDS work by reducing the production of prostaglandins in the body. Prostaglandins are chemicals in the body that promote inflammation.
Case 4 1. A doctor would most likely prescribe an analgesic to help relieve the pain of arthritis. Analgesics are drugs that help relieve pain but not inflammation. Acetaminophen is then used to treat the inflammation. 2.
GERD. Controlled and he feels that he needs the omeprazole. He has been on it since 2004 and it is unlikely that it is causing kidney disease given his renal stability. 7. Anticoagulation. He is on Coumadin, possibly also Lovenox, I am not sure of the reason and defer to the primary team.
Every medication has a side effects and adverse effects. In this case, treatment choices fall into four categories: pharmacologic, nonpharmacologic, surgical and complementary (Sinuasas, 2012). In this patient’s situation, pharmacological treatment should begin with acetaminophen and gradually move up to nonsteroidal anti-inflammatory drugs. NSAID therapy is recommended as a first line therapy for minimum to mild arthritis. However, since the patient indicates GI distress to NSAID medication (Naprosyn), other NSAIDS medications may be utilized.
Among those criteria mentioned above the intravenous medications, such as IV opioids, are well suited to fulfill the requirements. However, IV opioids have its drawbacks in that some patients may require such high doses of analgesia that there will be increased risk of respiratory arrest and loss of consciousness. These issues can be problematic in the early dressings change of superficial burns, while patient needs more frequent dressing change. In these cases, general anesthesia is the better solution to save the patient from
the patient should stop taking any antibiotics such as Pepto-Bismol, and proton pump inhibitors (PPIs) for two weeks before the test. Then, during the test, special solution contains urea that breaks down protein should be swallowed. The urea used is harmless and radioactive at the same time. Then, the specialist will recognize the presence of H. pylori. In existence of bacteria, carbon dioxide will be noticed and recorded in exhaled breath ten minutes later.
Mr. A is admitted to the critical care unit post bowel resection, splenectomy, acute respiratory distress syndrome (ARDS) and patient-ventilator dyssynchrony (PVD). He is an eighteen-year-old African American man who is placed on an IV infusion of Norcuron and Ativan. The major outcomes expected for Mr. A would be for him to be able to wean of the ventilator, be hemodynamically stable, heal adequately, tolerate his diet, have adequate bowel elimination, and be able to adjust to his life with optimal functioning. The problems that are to be manage include, being on the ventilator, being sedated, having an elevated temperature, having a low hemoglobin, post surgical bowel resection, splenectomy, hypoxia and diet intolerance.
Introduction 1. Background: Antimicrobial resistance is a global concern for effective health care delivery.(1) Extensive use of antibiotics in healthcare institutes is one of the main causes for emergence of antimicrobial resistance. (2) The misuse of antibiotics has also contributed to the growing problem of antibiotic resistance, which has become one of the most serious and growing threats to public health. Unnecessary exposure to antibiotics affects patients’ health seriously; suffering from serious adverse events with no clinical benefit, prolongation of hospital stay, prolonged treatment with antimicrobials or even the need for further surgical intervention; which causes a considerable burden on patients, health care system and the
Rowe, K., & Fletcher, S. (2008). Sedation in the Intensive Care Unit. Continuing Education in Anaesthesia, Critical Care & Pain, 8 (2), 50–55. doi:10.1093/bjaceaccp/mkn005 Roux, B. G., Liet, J., Bourgoin, P., Legrand, A., Roze, J., & Joram, N. (2017).
Tegaserod was shown to provide rapid, predictable, and consistent relief of chronic constipation.1 Additionally, only 1 percent of patients experienced significant adverse events but none of them were found to be attributable to the use of Tegaserod.1 In March 2007, the drug was pulled
In several case studies done on the subject of these medications and their relationship to the gastrointestinal system, it was found that corticosteroids, a subset of the larger group of steroids, are highly associated to abscess formation. This combined with the strong immunosuppressant nature means that healing times are slowed. This allows for increased infection rates of any perforations within the gastrointestinal system. On the other hand, NSAIDs have only been shown to harm surface epithelial cells and increase colonic permeability. The damage done by corticosteroids is more devastating on the system than the effects caused by the use of
No use of rescue medication scored as 0 and if used scored as 1. PONV score means the total no. of the patients who suffered either from nausea or emesis (vomiting/retching) or if needed rescue medication. A complete response was defined as the absence of PONV and no use of rescue antiemetics. Adverse events were evaluated and recorded by the investigator during the entire observation period. The primary outcome measure of this study was the incidence of nausea and vomiting during the first 24 h after surgery.