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    القرحة...(Peptic Ulcer) 2

    الناقل : elmasry | العمر :42 | الكاتب الأصلى : هبة الله | المصدر : sayadla.com

    كلمات مفتاحية  :
    قرحة المعدة مرض Peptic Ulcer

    Diagnosing of peptic ulcer and H.pylori



     

    (1)Diagnosing an Ulcer

     

    a) Apper gastrointestinal (GI) series
    . An upper GI series is an X-ray of the esophagus
    stomach, and duodenum.

    The patient drinks a chalky liquid called barium to make these organs and any ulcers show up more
    clearly on the X-ray

     

    b) an endoscopy
    ( منظار المعدة )
    An endoscopy is an exam that uses an endoscope, a thin, lighted tube with a tiny camera on the end.

    This allows the doctor to see the lining of the esophagus, stomach, and duodenum.

     

    . If an ulcer is bleeding, the doctor can use the endoscope to inject drugs that promote clotting

     

    المنظار هو عبارة عن أنبوب طويل مرن غير سميك مزود بإضاءة و كاميرا صغيرة في نهايته يستطيع الطبيب المعالج من توجيه بحذر لفحص النسيج الداخلي للجهاز الهضمي العلوي
    و ذلك بعد ضبط كافة أجهزة التحكم الأخرى المتعلقة به.
    و تعرض الصورة التي تمتاز بكفاءة عالية على شاشة التلفاز معطيةً بذلك رؤية واضحة و تفصيلية و في كثير من الحالات يعتبر منظار المعدة أدق من الأشعة السينية
    ويعد ذو فائدة كبرى في تشخيص و تقيم مشكلات مختلفة كآلام البلع و صعوبة البلع
    أو آلام المعدة و البطن، النزيف والقرح و كذلك الأورام .



     

    [LINE]hr[/LINE]



     

    (2)Diagnosing H. pylori

     

    If an ulcer is found, the doctor will test the patient for H. pylori.
    This test is important because
    treatment for an ulcer caused by H. pylori is different from that
    for an ulcer caused by NSAIDs


     

    H. pylori is diagnosed through
    blood
    or
    breath
    or
    stool
    or
    tissue tests.


     

    Blood tests
    are most common. They detect antibodies to H. pylori bacteria.
    Blood is taken at the doctor's office through a finger
    stick

     

    Urea breath tests
    the patient drinks a urea solution that contains a special carbon atom.
    If H. pylori is present, it breaks down the urea, releasing the carbon.
    The blood carries the carbon to the lungs, where the patient exhales it.


     

    Stool tests
    may be used to detect H. pylori infection in the patient's fecal matter.


     

    Tissue tests
    are usually done using the biopsy sample that is
    removed with the endoscope.
    فحص عينة القرحة الهضمية المأخوذة بالمنظار للتأكد من وجود أو عدم وجود البكتيريا

     

    ======قبل إضافة عينة القرحة +++++++++++=+تغير اللون للأحمر بسبب وجود
    +++++++++++++++++++++++++++++= =البكتيريا الحلزونية في عينة القرحة


     

    Treatment of Peptic Ulcer


     

    Firstly:
    Change your lifestyle
    Avoid spicy food , fatty food and Acidic food
    Stop Smoking

     

    [LINE]hr[/LINE]

     

    a)Antacid

     

    (MgOH +Al hydroxide)

     

    Mucogel

    May Cause Diarrhea


     

    (NaHCO3)

     

    fawar fruit

    not recomended for long time because it cause hypercalcemia and renal failure and salt water rtention

     

    [LINE]hr[/LINE]

     

    b)H2 Blocker
    Which decreace HCl Secretion


     

    (Ranitidine)
    Ranitidine
    1tab. 2 times Daily
    if 300 mg 1 tab. Daily only

     

    Zantac
    1tab. 2 times Daily
    if 300 mg 1 tab. Daily only


     

    Aciloc
    1tab. 2 times Daily
    if 300 mg 1 tab. Daily only


     

    (Famotidine)

     

    Peptec
    1tab. 2 times Daily


     

    (Nizatidine)
    Ulcfree
    1tab. 2 times Daily

     

    لم يذكر Cimetidine في H2 Blockers نظراً لآثاره الجانبية الخطيرة ومنها:
    Carcinogenic
    Gynecomastic in male
    Galactorrhea in female
    (Because it's Antiandrogenic)
    Decrease m e t abolism of anti coagulant,
    Thyophylline and Quinidine
    Decrease absorption of some drugs an minerals
    (Ketoconazole, Fe,B12)

     
    C)proton pump inhibitor
    Decrease HCl secretion


     
    (omperazole)

    Fast Cure
    1Cap. 1 time Daily


     
    Ulstop
    1Cap. 1 time Daily

     
    Gastroloc
    1Cap. 1 time Daily


     
    (pantoprazole)

    controloc
    1tab. 1 time Daily



     
    D)prostaglandin analogue
    Anti secretory + protective properties
     


     
    (Misoprostol)

     
    Misotac
    1tab. 3 times Daily






    Treatment of Heliocobacter Pylori


     
    Triple therapy=omeprazole+2Antibiotic s for14 days
     


    Heli - Cure
    1tab. 1 time Daily
     
    Counseling points on peptic ulcer


     
    it's our role



     
    Counseling is a sympathetic interaction between pharmacists and patients during which the pharmacist should



     
    Give sufficient information and advice to enable patients to use medicine effectively and safely


     
    Make sure that patients understand your instructions well, as counseling is not a lecture patients must be given a chance to ask questions



     
    a) Counseling points on diet and life style changes



     
    Øpatients of peptic ulcer disease can eat any thing and no specific food is contraindicated , but each patient know which kind of food can cause him pain , so he should avoid it





     
    ØPatients should stop smoking and drinking alcohols as they delay healing





     
    ØNSAIDs should be avoided ( in some certain cases NSAIDs must be taken , but under the physician supervision





     
    ØPatients should eliminate psychological stress




     
    b) counseling points on the medicine


     
    PPIs heal peptic ulcer more rapidly and shouldn’t be taken with H2 blockers

     
    - it is very important to persuade your patient that pain can be relieved before actual healing , so he should complete the coarse of treatment as recommended by the physician.


     
    PPIs (e.g. omperazole- lanzoprazole…et)c



     
    -One capsule or one tablet in the morning before breakfast from 4-8 weeks.


     
    -to be swallowed as a whole / disperse tablets in water or mix tablets and capsule with fruit juice and yoghurt

     
    H2- antagonists( ranitidine , famotidine…)

     
    -it is preferred to take them at night as the acidity of the stomach increases at night.

     
    Bismuth chelate

     
    to be swallowed with half glass of water

     
    -it may darken tongue and blacken faeces , so tell your patient that it is normal case..

     
    -it should be taken half an hour before food, or antacids as the decrease its activity.

     
    -Milk should not be drunk by it self during treatment , but small quantities may be taken in tea or coffee



    Scuralfate:

    Þ scuralfate can adsorb other drugs ,so dose spacing should occur 2 hours before or after its administration.
     
    Þ It is 1st line for smokers as it doesn’t delay their healing


     
    [LINE]hr[/LINE]


    N.B.

    Not every patient will require extensive counseling and advice , but pharmacist can correctly identify those who do.Not all the pieces of information should be given to the patient as he may get confused , so pharmacist should select the most important points which differ from one patient to another..But remember the dispensed medicine will be labeled with the essential information.

    Reference


    BNF2006





    كلمات مفتاحية  :
    قرحة المعدة مرض Peptic Ulcer

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