stomach ulcer

Mr. D, a 45 years old has been experiencing vague epigastric discomfort for the past 2 years and moderate loss of weight for the past 6 months. Endoscopy done revealed a large irregular ulcer in stomach. The margin is described as heaped up, the base is dirty, the surrounding mucosa is thickened. Biopsy was also done.

• What is the probable diagnosis expected in this patient? (1m)
• What are the expected microscopic findings of the biopsy? (2m)
• Outline the pathogenesis of the diagnosis mentioned earlier. (3m)

Wassalam.

identification data-epigastric pain

A 60 years old malay male initially having history of epigastric pain for the past one year,reduced after taking male, and elevated when he skipped the meal.Patient refused to seek medical attention since he is tolerable with the pain,but patient realized the pain start worsen for the past few months.Patient also noted dark colour stool for the past two month.Currently,came to the emergency department with acute abdominal pain and broad like rigidity.

please interprete the chest x-ray

• present of gas underneath bilateral hemidiaphragm
• CTR:0.5
• poor lung inflation-the 5th passing the hemidiaphragm midpoint

give the possible diagnosis at this stage
perforated peptic ulcer

list the possible investigation

• endoscopy
• full blood count
• blood urea and serum electrolyte
• urease test
• ABG

p/s;all answers were provided by kak zahid,exco kebajikan

help is help

how does hepatitis cause increment in both direct and indirect bilirubin?

jaundice

Lembut tapi Tajam

a. Describe abnormality in this picture.

The deviation of the protruded tongue to the right side (affected side)

b. What nerve is damaged?

Hypoglossal Nerve

c. State which muscles is paralyze.

Extrinsic muscle:

• Styloglossus muscle

• Hyoglossus muscle

• Genioglossus muscle

d. State clinical feature seen in this patient.

• Dysarthria

• Dysphagia

* Tongue deviate to the ipsilateral side of injury due to unopposed action of genioglossus muscle on the normal side of tongue.

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