Fitrianto Anwar

20110310158
Tutorial 11

Scenario
A 42-year-old woman, office secretary visits a hospital with complaints of
abdominal discomfort, post pranial fullness, and nausea, no vomiting. These
complain exist from 5 month ago. In physical examination founded only
epigastric pain and laboratory examination within normal limit. The family
doctors take specific laboratory examination, urea breathing test. This result
was positive for urea breathing test.

Step 1 : Clarifying Unfamiliar Terms

urea breathing test
diagnostic tool to diagnosis recurrent infection of H pylori
to detect bacterium called H pylori within the lining of the stomach
which is the cause of chronic gastritis
the patient will be given oral of urea label with carbon 30 or 40 then
analyze the C02
detect the H pylori to convert urea to ammonia
can be use to monitoring the success of eradication of H pylori,
performed at least 1 month
post prandial fullness
fullness as soon as she start to eat
Step 2 : Problem Definition
1. Why the patient fell post prandial fullness and nausea ?

2.
3.
4.
5.
6.
7.

Diagnosis ?
Treatment and Management ?
Is there any relation between her job and the symptomps that she had ?
Interpretation of urea breathing test ?
What kind of examination that can be use to diagnostic the patient ?
The step H pylori can cause the symptom ?

Step 3 : Brainstorm and Analyzing

1. Why the patient feel post prandial fullness and nausea ?
post prandial fullness : rapid inflow of gastric content into duodenum,
clearance of the gastric
gastric is empty hungry
when someone induct by something that can decrease the gastic
content (barium) inject with spasmoplastic to perform relaxation of
muscle and GIT walls post prandial fullness, found rapid inflow of
gastric content
nausea : chloric acid will stimulate the centre of the brain to feel
nausea
PATOFISIOLOGI
- Because helicobacter pylori in the stomach caused inflammation so she
has epigastric pain. Helicobacter pylori infected rute is oral to oral or
fecal oral. Helicobacter pylori has urease so they have a shield to protect
them from acid in gaster. They live between a cell. It can caused
inflammation.
- after gaster inflammation it can caused duodenal ulcer. Acid in gaster is
increased to against helicobacter pylori, so it can make epigastric pain
- common caused of upper abdominal pain : acid reflux, gastritis, peptic
ulcer disease, inflammation of pancreas, gall stone, infection in gall
bladder
- medicine : drug make interaction with the organ so that make epigastric
pain. But it not directly caused epigastric pain. Such as ibuprofen make
bleeding of gaster if it overdoze

- NSAIDs can suppress synthesis of prostaglandin in mucus gastric.

Prostaglandin is one of protector in gaster so if its suppress it can make
irritation in gaster.
2. Diagnosis ?
Functional dyspepsia cause by H pylori
If urea breathing test + infection of H pylori
The symptom usually not detected, only can be detect by supporting
test like urea breathing test, serology test (leucocyte in normal limit)
Dyspepsia
a.

Organic disorder in gastroduodenal ulcus, the laboratory in normal

limit

EPIDEMIOLOGI
- epigastric pain caused by helicobacter pylori 8 out of 10 people. With
higher rate in developing country. Helicobacter pylori contacted by food.
3. Is there any relation between her job and the symptomps that she had ?
Yes. The habit and the lifestyle of the patient can cause the symptom (like to
eat)
4. Interpretation of urea breathing test ?
if the H pylori present, it will change the urea into ammonia in CO2, so the
result is positive
5. The step H pylori can cause the symptom ?
H pylori can cause ulcer by growing in the lining of the stomach, can
produce inflammation stomach and intestinal lining easily damage
H pylori lives in stomach mucosa, ammonia can cover the body so the
H pylori can lives (because of acid condition) stimuli G cell D
cell decrease somatostatin decrease, gastrin increase chloric
acid increase damage the stomach ulcer
Ulcer can cause dyspepsia (dyspepsia in the symptom of peptic ulcer)
6. What kind of examination that can be use to diagnostic the patient ?
Laboratory test : blood test (immunoserology test) to identifying the
antibiotic (the result is negative not infected by H pylori)

 Urea breathing test (didnt take antibiotic for 4 weeks, PPI and H2
Blocker for 2 weeks before test, fasting for 6 hours)
Endoscopy : perform by gastroenterologist send to the lab
10 level of tissue in stomach identifying in the microscope
Physical examination : epigastric pain, Carnet sign (abdomen
tenderness)
7. Treatment and Management ?
Medicine : antacid, H2 blocker, PPI (reduce the stomach acid, ex :
omeprazole, lansoprazole, etc) antibiotic (ex amoxcicilin) amoxicillin
clarithomicyn (if the patient have allergy of amoxiciln)
+
metronidazole twice/day in 7 days, prochinetic drug (ex sisapri,
domperidone, metoclopramide).
Bismuth + metronidazole + h2 blocker + tetracycline
Bismuth -- > as a companion of antibiotic, make antibiotic work more
effective ( ex antacid and adsorbent)
Effective : PPI + amoxicillin + clarithomicyn 90-95%
PPI + metronidazole + clarithomicyn : 88 95%
Manage the lifestyle : diet, stop smoking, alcohol, didnt eat spicy
food