Concluded Case

Chronic Motion sickness with GERD

Age 45 years male has complaints severe chronic motion sickness along with GERD since from 20 years H/o DTM, HTN under controlled H. Pylori positive HBSAG +ve Thyroid profile normal RFT, LFT Normal Endoscopy- Normal Now patient is under medication Tab. Normaxin BID Tab. Amlong At Cap. Omeprazole D Tab . K Glim M1 Kindly suggest further evaluation Dx & Rx

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DM , HT with chronic hepatitis B and acid peptic reflux disease Adv 1) Proton pump inhibitor with GI motility agent for treatment of reflux oesophagitis ESoz D 40 mg once daily Itopride 50 mg one tablet three times a day 2) Strict control of diabetes and hypertension 3) H. Pylori treatment - RUT kit shows negative result as the disc is yellow in colour, positive result will have pink colour in the disc Adv - urea breath test to confirm H. Pylori infection 4) Hepatitis B surface antigen positive status Treatment of hepatitis B is indicated if A) Sonography shows cirrhosis of liver B) HBeAg is positive C) APRI index is more than 2 D) HBV DNA is more than 2000IU/ml

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DM , HT with chronic hepatitis B and acid peptic reflux disease Adv 1) Proton pump inhibitor with GI motility agent for treatment of reflux oesophagitis ESoz D 40 mg once daily Itopride 50 mg one tablet three times a day 2) Strict control of diabetes and hypertension 3) H. Pylori treatment - RUT kit shows negative result as the disc is yellow in colour, positive result will have pink colour in the disc Adv - urea breath test to confirm H. Pylori infection 4) Hepatitis B surface antigen positive status Treatment of hepatitis B is indicated if A) Sonography shows cirrhosis of liver B) HBeAg is positive C) APRI index is more than 2 D) HBV DNA is more than 2000IU/ml

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HBsAg +ve suggest under treated needs to evaluate for viral loads and plan to keep on antivirals like heptavir or tenfovir Second thing is H pylori +ve Endoscopy in my opinion shows chr DUODINITIS hence anti H pylori Tab amoxyclav625mg 1bd for 15days Tab clarithromycin 500mg 1bd for 15days Tab meteronidazole 400mg 1tds for 5to7days Tab albendazole 400mg 1stat Pantaprazole dsr 40mg 1od for couple 9f months Ondestron 4mg as per need Tranquillisers at bedtime Add hepatocellular regeneratives Hepamerz Essentiale-L Udco Or alternative medicines like phillenthis niruri Tab Rifaximin 200mg 1tds Keep control of comorbidies Diet restrictions And monitor periodically

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GERD with T2DM with HTN with HBSAg +ve with H.Pylori +ve Cap Pyloflush one tab twice daily for H.Pylori Replace Amlong AT to Telista MT 25 OD, ARBs and Cardioselective beta blockers are comparatively better in T2DM patients, Change Omez D to Protera D OD 30 mins BBF, Also can add syp digeraft 10ml at bedtime Further workup for Hep B is needed

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NEED'S.. MANAGEMENT FOR.. H PYLORI.. WITH.. PPI .. AMOXICILLIN.. CLARITHROMYCIN.. WITH.. TREATMENT FOR.. HBSAG +VE ..

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Peptic Ulcer-advise your patient a proper diet routine with following medicines. 1-ptolyadi Kawath 20ml after meal 2-Avipatikar churan+Lilavlas ras before meal 3-Bhoiamala churan at bed time. hepatitis B-with titres My experiance says its very hard to reverse HBV +ve to -ve. Still you can decrease quantitative viral load significantly. You should use.... 1. Phalatrikadi Kashay 2. Arogyavardhini Ras 3. Nitya Mrudu Virechana 4. PathyaPathaya of Paandu & Kaamala. FATTY LIVER he must avoid fatty and spicy food.continune bhoeamalki and rohitikarist

Treat for H pylori. See the detailed evaluation considering chronic active hepatitis.

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Naturolax powder with curd 2 times in day time 2 tsf with milk at bed time

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GERD with Hepatitis B with H.pylori written positive on report but negative on Rapid Urease Test kit. Advised to repeat RUT Kit. USG Abdomen CECT whole abdomen Viral load APRI Index Rx- Triple Drug Regimen Therapy including PPI+ Amoxicllin+ Clarithromycin. If DM & HTN under Control,then continue same drugs. If want to change,use Telmisartan or Olmesartan 40 mg instead of Amlodipine + Atenolol combination already in use as Telmisartan/Olmesartan decrease the blood sugar level and lipid level through its activity of blocking action of angiotensin II on AT1 receptor and promoting the activity of adiponectin and decreasing the activity of adipokines. Tab UDCA 300 mg BD

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Triple therapy using a proton pump inhibitor or ranitidine bismuth citrate, combined with clarithromycin and amoxicillin or metronidazole.

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Rx Abhyadi qwath BD Galo ghan tab 1bd Panchsakar powder HS for 1 to 2 weeks,

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