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To diagnose a gastric ulcer, the best way is through the gastroscopic procedure.

This consists of a flexible tube that has a built-in camera, so that you can see clearly the walls of the stomach and duodenum. It allows us to know the location, size, shape and presence of other associated lesions.

Other test that can be used for the diagnostic is:
- biopsies through the gastroscope.
- presence of Helicobacter pylori, bacteria.

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-Strong abdominal pain that gets worse when eating or drining.
-Sickness, vomiting, headache.
-Bleeding in the wall of the stomach that makes the appearance of dark feces.
-Heartburn in the middle of the abdomen.
-Feeling of fullness.

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Name the symptoms shortly. Who are the people who usually have this condition?

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Give generic names and dosages. Also, give examples of trade names (mark it with ® to make it clear for others). What route do you usually use to give the medication? Is it a course or a single dose?
Are there any side-effects?

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heart related e.g. angina, pericarditis, aortic dissection, myocarditis infaction

digestion causes e.g. gastroesophageal, gaubladder stones

mussel and bone causes eg. sprains and strains, bone fractures

lung related eg. pneumonia, pneumothorax, lung cancer

Other causes

Shingles

panic attack

All organs and tissues in chest area can be the cause of chest pain, but each condition has their own characteristics.

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Immediate tests:

ECG

Blood tests

Chest X-ray

CT-scan

Auscultation heart and lungs

Follow up testing

Stress test

Coronary catheterisation

CT-scan

Angiogram

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Medication treatment and surgical treatment

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Medication treatment and surgical treatment

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Medication depends on the underlying reason for chest pain.

Medication for the acute coronary artery attack:

artery relaxes e.g nitroglycerin i.v./p.o.

aspirin 250-500 mg p.o. chewing

Pain killers when needed: eg. morphin/oxycodone i.v.

Betablocker i.v. (eg meroprolol) if the patient has high P/BP

Based on the underlying cause:

acid suppressing medication

antidepressants

antacids

antibiotics e.g. zinachef, meropenem

diuretics e.g. Furosemide (furesis)

muscle relaxants

Surgical treatment (only in severe cases)

Angioplasty and stent placement

Bypass surgery

Dissection repair

Lung reinflation

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- Physical examination and review of medical history,
- Peak flow test,
-Spirometry,
- FeNO test,
- Allergy test,
- Bronchial challenge test (direct challenge test)

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Tremors, hallucination, Shivering, Agitation, Sweating, pale skin, fever, fear, confusion, fatigue, nightmares, Palpitation.

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An inability of the heart to pump an adequate amount of blood to the body's need.

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An inability of the heart to pump an adequate amount of blood to the body's need.

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1. Chest pain while coughing or breathing
2. Confusion or changes in mental awareness
3. Fatigue
4. Fever, shaking and shaking
5. Nausea, vomiting or diarrhea
6. Shortness of breath
7. Lower body temperature than normal ( in adults >65 or people with weak immune system )

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- Physical examination including auscultation of lungs sound
- Blood test (complete blood count, blood culture) to identify infection
- Chest x-ray
- Sputum test
- Arterial blood gas test

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-Penicillin:  Amoxicillin® 750 mg-1 g p.o. (children: 15mg/kg; maximum 500mg) orally every 8 hours for 5 -7 days at home OR Cefuroxime® 1,5 g x 3-4 i.v. in hospital care. Side effects include e.g. diarrhea, nausea and vomiting.
Antibiotic course can be finished when the patients has not had fever for minimum 2-3 days)
-Bronchodilators: Salbutamol, short/long acting, side-effects include e.g. nausea, muscle cramps, dry mouth.
-NSAIDs: Burana. Side effects include e.g. abdominal pain and diarrhea.
-Oxygen therapy
-IV-fluids

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Shortness of breath
Chest pain or tightness
Difficulty in sleeping
Coughing or wheezing attacks
Increasing difficulty in breathing
Feeling tired

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For the left sided heart failure:
-Restlessness
-Confusion
-Orthopnea
-Tachycardia
-Dyspnea
-Cyanosis
-Cough
-Crackles
- Blood tinged sputum
Right sided heart failure:
- Distended jugular veins
- Anorexia and complaints of GI distress
- Swollen hands and fingers
- Dependent edema
- Fatigue
-  Enlarged liver and spleen

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-Blood-magnesium level,
-ECG,
-Blood-phosphate level,
-EEG, Toxicology screen,
-Comprehensive metabolic panel.

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Saturation, Blood gas analysis,
Chest Xray to check the condition of the heart and lungs, ECG, echocardiogram to see the image of the heart, CT scan,
Blood test to check for the signs of disease (P-BNP), Coronary angiogram

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Long-term asthma control medications:
Short acting asthma control inhalated medication (bronchodilatators)
ex.Ventoline®- salbutamol
Ipramol® - ipratropium
Inhaled corticosteroids.
ex:  Symbicort®/Pulmicort Flexhaler® (budesonid) OR Formotelor easyhaler® (formoterol) to treat the inflammation
- Leukotriene modifiers
ex: Montelukast p.o.

If this medication is not enough, also cortison-medication p.o. can be possible.

Common side effects:
-bad for the teeth
-allergic reaction might appear

-shaking and trembling of arms and feet
- stomach pain
- chest tightness
-Inhalated drugs don't have many side-effects since they affect locally.
Administration:
- delivered by inhalation or oral

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-Sedatives to calm agitation and treat anxiety: diatzepam (Diapam® 10-20 mg p.o. every 1-2 hours until the patients calms down or sleeps OR ad maximumdosage 200 mg/day. Monitor respiration rate + orientation.
-B-vitamin (tiamin: Neuramin®) 250 mg dosage 1x1 i.m./i.v. for three days (prevents Wernickes enkefalopatia)
-Anticonvulsants to prevent or stop seizures (Carbamazebine®, first dosage starts from 100 mg/day p.o.).
-Intravenous fluids.
Other treatment-methods
-Supportive care (mental treatment),
-treatment for other alcohol-related conditions,
-antipsychotic medications to prevent hallucinations.
-Stop drinking.

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In Acute care:
Vasodilators like ACE inhibitors, decrease the work load of the heart (Enalapril->5 mg /day)
Side-effects: Dry cough, fatigue, Hyperkalemia, dizziness, loss of taste, headache.

Diuretics (Lasix® 20-80 mg / day p.o., in ER furosemidi i.v. eg 20-40 mg i.v.)
Side-effects: headache, dizziness, muscle cramps, thirst, low sodium level, high potassium level)

In chronic phase ACE-blockers+diuretics AND:
Beta blockers (Bisoprolol-> 2.5 mg/ day)
-Side-effects: slow heart beat, diarrhea, dizziness, SOB, swelling

Digoxin to increase the strength of the heart (400-600 mcg as initial dose and 125-500 mcg as maintenance dose)
Overdose of Digoxin may cause POISONING, symptoms of Digoxin poisoning: nausea, vomiting, swelling of the lips/ face, dizziness.

Route of administration: ORAL

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-Hypotonia (Diazepam-for alcohol withdrawal)

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headache

diarrhea

constipation

fatigue

rash / redness / itch

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Antibiotic like Amoxicillin for eliminate H.Pylori bacteria. 750mg - 1g / 12 h. p.o.

Omeprazole: blocks the acid production and help healing. 20 mg p.o.

Ranitidine or Cimetidine: decrease the acid production.

Ranitidine: 300 mg p.o. / i.v.

Cimetidine 800 mg p.o. / i.v.

Antiacids: neutralize stomach acid.

Sucralfate or Misoprostol: protect the lining of the stomach and small bowel.

Sucralfate: 1g /4 times per day. 1h before eating. p.o.

Misoprostol: 200mcg /4 times per day. p.o.

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Occur when the thick wall or layer of mucus that protects the stomach from digestive juices is reduced and is due to:

• Genetic factor
• Use of medication that afects gastric wall defences. For example nonesteriodal antinflamatory drugs (NAIDS): aspirin, ibuprofen
• Infection from helicobacter pylori, which weakens the protective barrier
• Excess use of alcohol
• Stress
• Zollinger-ellison syndrome: increase body production of acid

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The side effects of the medication for gastric ulcer are:
- Nausea
- Dizziness
- Headaches
- Diarrhea

- Abdominal pain