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Pn. Fatimah, 35, investigation, history, sign & symptoms, examination …
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investigation
peptic ulcer
- NSAIDs block COX pathway.
- Inhibit the production of PG and thromboxane.
- No production of PGI₂, no secretion of mucous that protect stomach from gastric juice, leading to erosion on the wall of the stomach eventually causing ulceration. Blood loss occur.
- At the same, production of thromboxane A₂ which function to increase platelet aggregation are also inhibited. No blood clot occur, exacerbating the blood loss.
- Blood loss increase erythropoiesis, increasing the physiological demand of iron use.
- She also has been taking antacid medicines to relieve epigastric discomfort by neutralizing gastric juice that help with iron absorption, this cause impairment on iron absorption
- Excessive blood loss, high physiological demand and low iron absorption cause iron deficiency.
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low MCH
indicate microcytic, small size RBC
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low serum iron
due to blood loss, low iron absorption and high physiological demand
high TIBC
indicate low iron, high tendency for transferrin to bind to iron
low serum ferritin
blood protein that contains iron, low serum ferritin indicate low iron content
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sign & symptoms
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frequent bloating, belching and epigastric discomfort
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