H. Pylori

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents for a positive H. Pylori on ‍serologybreath teststool test

Symptoms include:

‍epigastric pain

‍heartburn

‍bloating

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍belching

‍loss of appetite

‍unexplained weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths

‍dark, tarry stools



Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍smoking

‍high alcohol consumption

‍poor diet

‍stress

no history of: ‍H.pylori infection, ‍peptic ulcer disease, ‍gastritis, ‍stomach cancer, ‍anemia, ‍upper gastrointestinal bleeding

no use of: ‍NSAID





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍





ASSESSMENT:

‍H. Pylori Infection ‍likelysuspectedpossible

DDx: peptic ulcer disease, gastritis, NSAIDs gastritis, alcohol-related gastritis, gastric MALT lymphoma, iron deficiency anemia, idiopathic thrombocytopenic purpura, gastric cancer, Zollinger-Ellison syndrome, GERD, celiac disease, inflammatory bowel disease, lymphocytic gastritis, eosinophilic gastroenteritis, gastrointestinal bleeding, gallstones, pancreatitis





PLAN:

Investigations:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍LFTs, ‍lipase, ‍H. pylori serology

- Stool test for H. pylori

- Breath test for H. pylori

- Upper GI endoscopy

Treatments:

- ‍H. pylori treatments

- ‍PPIs

- ‍H2 blockers

- ‍Other antacids

- Avoid NSAIDs

- Dietary modifications: ‍avoid spicy foods, ‍avoid alcohol, ‍avoid caffeine, ‍avoid acidic foods, ‍avoid fatty foods, ‍avoid carbonated beverages, ‍avoid dairy products

- Smoking cessation counseling

Further care:

- Referral to gastroenterologist

- Follow-up in ‍ ‍daysweeksmonths

- Return if symptoms worsen or if new symptoms develop such as vomiting, weight loss, or black stools