Notes: Modified from OSCE Professional III 2004, station 23. Other kit for this method is called as Pronto test which having similar principles with CLO test.
Questions
1)What is the name of the test that
use above kit? (2m)
2)Outline the steps to use the
test? (2m)
3)What is the principle of the
above test (1m)
4)How to interpreted the test (1m)
5)3 other test to confirm the
organism
6)How do you manage the patient
with positive results? (4m)
Answers
1)Rapid urease test
2)Steps
a)Peel back the adhesive cover
b)Place one or more biopsy specimen
on the test yellow dote, reseal and press the label over the dot with your
finger to squeeze the tissue juice out of specimen.
c)Monitor the result after one
minute and up to 60 minutes
3)The basis of the test is the
ability of H. pylori to secrete the urease enzyme, which catalyzes the conversion
of urea to ammonia and bicarbonate. The alkali product then reacts with the
chemical substrate in the test kit and produce positive result.
4)Interpretation of the test
a)Positive result may indicate the
presence of H. pylori organism
5)Confirmation of H. pylori
-Gram stain and microscopy of
biopsy
-Culture of biopsy
-Serological test for IgG antibody
to H. pylori
-Urease breath test (not available
in USM)
6)Management of H. pylori induced
peptic ulcer disease
a)Giving the triple therapy for one
to two weeks consisting of 2 antibiotics and one proton pump inhibitors, for
examples
-Tablet Omeprazole 0.8 mg/kg daily
(approximately 40 mg In adult)
-Tablet Metronidazole 8mg/kg tds
(approximately 400 mg in adult)
-Tablet amoxicillin 10mg/kg tds
(approximately 500 mg in adults)
-Or, Metronidazole can be replaced
with tab clarithromycin 7.5-15 mg/kg bds.
b)If the triple therapy fails to
eradicate the H. pylori, may use quadruple therapy
Omeprazole + Bismuth subsalicylte +
Tab. Tetracycline + Metronidazole
c)Withdrawal of any offensive drugs
like NSAIDs
d)May add drug for mucosal
protective barrier like Sucralfate or antacids like MMT.
