GI1 Case A New Patient

You're the new GI doctor in a DC practice. It's your first day and you meet Mr. Harper. He was referred to you by his primary care, whom he only recently started to see again. He's been having episodes of dark stools that he thought was normal until his wife noticed and commented on the strange color. He says it's been happening for a while now, but it wasn't until he was denied from donating blood recently, for having an iron deficiency, that he decided to get checked out.

You read the brief note sent from his primary care doctor.

"59 yo M p/w 2 year h/o of melena and iron deficiency. He has had increasing episodes of nausea and NBNB vomiting over the last year; once a week. Describes sense of post  prandial fullness.

PMHx: Osteoarthritis.
Meds: Aspirin and PRN Ibuprofen"

What is the top diagnosis you are considering?

You've started to worry that your patient's issue has become a chronic process. What major issue do you notice in your patient's history, could be causing the problem?


What malignant process are you worried about should your patient's problem continue to be unmanaged?


You do an endoscopy and you find a 1cm gastric ulcer near in the fundus of the stomach.

Describe what you see

You decide to order a urea breath test. (WHY? ) By chance, you receive the result the same time as your gastric ulcer biopsy you performed during endoscopy. Describe what you see on the following slides.

(IMAGES FROM UTAS)

 Gram Stain and Cx from endoscopy

What is another clinical test you can use to detect H. pylori? What is another useful feature of this test?

What other diseases are associated with H. pylori?