Question

Question from Informatic pathology subject in bioinformatics, need answers in essay form for 25 marks

A 42-year-old man was admitted to hospital regarding epigastric burning or aching pain, nausea, vomiting, bloating, belching and weight loss. He also complained that the pain become worse at night and 1 to 3 hours after meal. Endoscopy showed a punched out defect with smooth “clean base” and less than 4 cm. In addition, biopsy showed the presence of S-shaped rod bacteria. Based on the clinical findings, name the probable disease the patient suffers from. Outline the etiology, pathogenesis, clinical manifestations and diagnosis.

[25 Mark]

Answer 1

Patients suffer from a duodenal ulcer caused by Helicobacterium pylori.

Aetiology:

* Here the main cause of developing duodenal ulcer is due to Helicobacterium pylori infection.

* Other factors include hypersecretion of acid-pepsin, alcoholic liver cirrhosis and tobacco use.

*Hyperparathyroidism

*Chronic pancreatitis and other genetic factors.

Pathogenesis:

*There is an increase in the secretion of gastric acid during the night in the stomach due to vagal stimulation.

*Helicobacterium pylori-induced duodenal ulcer is common. Through the following mechanism, H.pylori colonize on duodenal mucosa.

1. Duodenal mucosal defence is broken by bacterial enzymes like urease, protease, catalase and phospholipase.

2.H.pylori infected mucosal epithelium releases proinflammatory cytokines such as interleukin-1,interleukin-6,interleukin-8 and tumour necrosis factor, these all will increase inflammatory responses.

3. It also leads to immune responses that contribute to epithelial cell apoptosis.

Clinical manifestations:

* Pain is relieved while having food.

* Pain occurs during the night is common.

* No vomiting.

* Deep tenderness in right hypochondrium

* Dark stools more common than haematemesis

*No loss of weight

* Occurs more in people at greater stress.

Diagnosis:

1.Endoscopic biopsy of the gastric mucosa.

* A piece of biopsy material put in a urease indicator medium shows a positive result in a short time and is done inside the endoscopy room.

*Microscopy of sections by gram staining is useful. It is catalase and oxidase-positive organism.

* ELISA test can be used.

* Urease breath test- the patient is allowed to drink a carbon13 isotope containing urea solution. The test is positive when the breath of patient having carbon 13 isotope suggests H.pylori infection. It is sensitive and reliable.