2)¨**********APA norms (All paragraphs must be narrative and cited in the text- each paragraphs) 4) References not older than 5 years 5) Each answer must

2)¨**********APA norms  (All paragraphs must be narrative and cited in the text- each paragraphs) 4) References not older than 5 years 5) Each answer must be identified according to the question number. Check the list of questions. Your answer should start objectively answering the question Question: 1)………… 2)………… 3)………… Answer: 1)………… 2)………… 3)………… “I have recurrent H. Pylori infection”. M.C. a 46-year-old Hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has PMH of dyspepsia, and GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms. Diabetes Mellitus, type 2 High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago. Both parents are alive. Father has history of DM type 2, Tinea Pedis. Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis. Constitutional: Negative for fever. Negative for chills. Respiratory: No Shortness of breath. No Orthopnea. Cardiovascular: No edema. No palpitations. Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain. Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored : No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. :: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results. Urea breath test 8 weeks after treatment with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test. No new labs are needed. : may refer based on effect of medication therapy given for 2 weeks. return to office in 8 weeks to reevaluate symptoms. Questions: 1) determine the medications and treatment for recurrent H. Pylori infection. 2) discuss new therapy guidelines for H. Pylori treatment 3) determine patient education in this case.

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