Upper GI Cases

UPPER ABDOMINAL PAIN

40 year old female. Presents with 24 hour of gradual onset of constant aching upper abdominal pain radiating to the right upper quadrant and has developed a fever. She is moderately overweight and is running a temperature. She is markedly tender in the right upper quadrant and gasps when she breathes in when your hand is pressing over this region.

62 year old male. Presents with several hours of epigastric pain radiating to the back associated with several episodes of non-bilious vomiting following an alcohol binge. He is markedly tender over the epigastrium.

35 year old female. Presents with vague upper abdominal discomfort over several days and noticed skin and eyes turning yellow and urine becoming dark. History of IV drug abuse. On examination is jaundiced and is tender over her right upper quadrant.

55 year male. Presents with an hour of severe epigastric pain associated with nausea and sweating. His has a past history of diabetes and heavy smoking. On examination he looks very anxious with diaphoresis.

PATHOLOGY OF THE UPPER GI TRACT

A 45 year old man presents with abrupt onset of upper abdominal pain radiating to the back. He has a history of progressively worsening indigestion and heartburn for several months which has never been investigated or treated. On examination he is mildly tachycardic and has a rigid abdomen.

A 70 year old man with frequent heartburn and waterbrash has been treated by his doctor for 3 months with PPI with poor response. This included a course of two different antibiotic regimes after a hydrogen breath test was positive for H.Pylori. The patient also suffers from severe arthritis that he finds difficult to control with paracetamol . The patient was also advised to stop smoking. Why is he not responding?

20 year old male with recurrent peptic ulcers disease confirmed on endoscopy. despite regular therapy. Serum gastrin level is elevated.

A 50 year old with severe alcoholic liver disease presents vomiting copious amounts of blood. On examination he is yellow, has a distended abdomen with veins coursing over his abdominal wall. Why is he bleeding?

GI PHYSIOLOGY

A 8 week old infant presents with multiple episodes of projectile vomiting. His serum biochemistry showed severe metabolic acidosis with hypokalaemia. What part of the GI tract is obstructed and what is the reason for the blood chemistry?

GASTRIC PHARMACOLOGY

A multi-arm trial is performed on major burns patients to prevent 'stress-ulcers'. Various side effects are observed to occur. Drug A - diarrhoea. Drug B - black stools, Drug C - hypercalcaemia and metabolic alkalosis. What are the mechanism of action of these drugs to prevent peptic ulceration.

A patient presents with severe haematemesis (vomiting blood) to the Emergency Department. He is given fluid resuscitation and an infusion of a drug that reduces acid secretion, decreases GI blood flow and motility is given. How do you think this drug works?

A drug typically given for treating peptic ulcers is used to treat a patient with anaphylaxis. By what mechanism does this drug work.