1 Dyspepsia How differently would you manage these two scenarios: (10 marks) a) A 25y old who presents with epigastric pain, early satiety and bloating on and off for the past 4 weeks transiently responsive to antacids, had a negative H por stool wy antigen test. b) A 60y old who presents with similar symptoms as in (a) but for 12 weeks, without any Prior episodes, has a positive FOBT Pr Negative stool H pylori Ag test. ver nee 7 Coe _ : * 2) Intestinal Obstruction: pete os 2)Compare and const small bowel and large bowel obstruction. (6 marks) ae * b) What isadhesivel small bowel gbstruction? (2 marks) ———> * oz ee pam ye ©) When is surgery indicated? (2 marks) 7M ee “X” Reate abdomen: A 35year old female presents with progressively worsening abdominal pain and distension for the past 3 days, she reports nausea and vomiting, She has not passed flatus or stool in 3 days. In the past 6 weeks she was give triple therapy due to complaints of persistent epigastric discomfort followed by 2 positive’stool antigen H pylori test. Her 7 LNMP was 3 weeks ago. On physical examination she is sick looking, dehydrated with a “PR of 102 and BP 95/55 mmHg. The abdomen is moderately distended and. not moving with respiration. On auscultation the bowels are not audible and rebound tendemess is _ elicited. 57,252) What are the differential diagnoses and why? (10 marks) - ss ees 5 Outline in fair detail how you would go about this situation (15 marks) l= ntation, investigations i 4. Emergency situations (aed efine, outline clini and treatment potions) a) Massive upper GLibleed in a 40-year-old male with history of iver cirrhosis. (15 marks) Tb) Acute urinary retention in a 70-year-old male. (15 marks) as ©) Compartment syndrome in 25) old male with a closed fracture tbia/ibula, with 2 — cast on for past 18 18 hours. 15 marks) ad