212. A 39-year-old patient complains of acute weakness, headache, decreased appetite, weight loss, leg swelling. He has been suffering from kidney disease for 5 years. Objectively: pale skin with jaundice, pastosity of the face, edema of the legs. CBC: Hg-70 g/l, erythrocytes-2.8x1012/l, leukocytes-5.8x109/l, ESR -29 mm/h. Biochemical blood test: specific gravity-1012; protein-1.5 g/l; leukocytes-4-5; erythrocytes-5-6. What investigation is necessary to clarify the diagnosis?

213. A 42-year-old woman has been suffering from hypothyroidism for more than 10 years. She has been taking euthyrox in a daily dose of 75 mcg for a long time. The patient still has dry skin, constipation, memory impairment and drowsiness. On examination: TSH level increase. What should be changed in treatment tactics?

214. A 47 year old woman, 160cm tall and weighing 84kg, is accidentally found to have an elevated fasting blood glucose of 6.9mmol/l. What to do in this case:

215. A 17-year-old patient complains of thirst, dry mouth, weight loss. Examination revealed blood glucose 11.5 mmol/l, blood cholesterol 6.5 mmol/l, blood creatinine above 120.5 µmol/l, signs of ketoacidosis. Examination by an ophthalmologist - cataract. Your diagnosis and further tactic:

216. A patient with type 1 diabetes mellitus, decompensated, with high glucosuria, acetone in the urine (+++) is seen. What is the doctor's tactic:

217. A 52-year-old woman complains of weakness, drowsiness, decreased hearing. Dry skin, muffled heart tones, bradycardia, BP 120/90 mmHg, leg oedema. ECG: low amplitude and flattening of T wave. EchoCG: decreased cardiac output. Urine test: moderate proteinuria. What additional test should be ordered:

218. A 62 year old woman, weight gain, weakness, swollen face, dry skin, constipation, amenorrhoea, memory impairment. Her skin is dry and cold. Thyroid gland is not palpable. BP - 90/60 mmHg, pulse - 52 per min. T3, T4 are decreased, TTH - increased. What treatment need to the patient?

219. Patient is 65 years old. He is 160 sm tall and has a body weight of 105 kg. He has no complaints. His fasting blood glucose level is 7.0 mmol/l. Choose the management tactics for this patient:

220. Patient I. 48 years old with complaints of headaches, leg swelling, shortness of breath when walking, weakness, poor appetite. Kidney disease for 10 years. On physical examination: pale skin, swollen feet. Blood count: Hg-96 g/l; erytrocites-2.8x1012/l; WBC-8.8x109/l; ESR-35 mm/h. Urea-16 mmol/l, creatinine 250 µmol/l. The urine sample: specific gravity - 1005; protein -4.5 g/l; leuk-6-10 ; erytrocytes-20-25; hyaline casts - 2-3. What examination is necessary to clarify the clinical diagnosis?

221. A 29-year-old woman complains of lower back pain more on the right side, headaches, fever up to 38°C, frequent urination. She has been suffering from pain for more than 4 years, has been treated several times, she associates this aggravation with foot chill. Objectively: puffy, pale face, pastous eyelids. Positive tapping symptom. Complete blood count: Hb-114g/l, WBC 9.8x109/l; ESR-34 mm/h. Urinalysis: specific gravity 1.025, protein-0.99 g/l, WBC - little amount; casts 2-4. What investigation is necessary to clarify the diagnosis?

222. Patient I., aged 60, was treated for a trophic ulcer with no effect. He has been receiving glibenclamid for a year. Skin is dry, no oedema. BP-135/80 mm Hg. Heart rate-82 per minute. Status localis: the right foot was hyperemic, moderately edematous, there was an irregularly shaped ulcer on the dorsal surface approximately 4.5x6.1 cm in size. Peripheral vascular pulsation in the right foot was impaired. Blood sugar - 15 mmol/l, daily glucosuria - 29 g/l. What is the patient's management tactic?

223. In case of gout arthritis, it is necessary to determine:

224. Crunch in knee joints when moving and pain when walking, passing at rest; uneven narrowing of joint slots and osteophytes are characteristic of:

225. What complication of peptic ulcer causes weakness, nausea, loss of appetite, constant pain in the epigastric region, weight loss?

226. In what disease is heartburn the leading symptom of?

227. The leading symptom of what diseases is gastric dyspepsia?

228. What is the leading aggressive factor that contributes to the development of GERD?

229. Suspicion of a complication of peptic ulcer (perforation, penetration, ulcerative pyloric stenosis, malignancy) is an indication for consultation:

230. The main complaints in nonspecific ulcerative colitis:

231. In the treatment of mild ulcerative colitis, the drug of choice is:

232. In order to identify the level of exocrine pancreatic insufficiency, the most informative method is:

233. A high level of transaminase activity in the blood serum indicates:

234. A characteristic clinical sign of chronic pancreatitis is:

235. Decisive role in the diagnosis of chronic hepatitis is:

236. An early (manifesting) sign of primary biliary cirrhosis of the liver is usually:

237. For the latent form of chronic pancreatitis, the most characteristic coprological sign is:

238. The most important etiological factors of the development of cholecystitis are:

239. When the ulcer penetrates into the pancreas, the following increases in the blood:

240. What groups of drugs are used to treat chronic viral hepatitis C?

241. What changes in biochemical parameters are characteristic of cholestasis?

242. Portal hypertension can be observed in:

243. The causative agent of acute rheumatic fever is:

244. An 18-year-old girl revealed systolic tremor above the apex of the heart, which is typical for:

245. Which of the following signs are characteristic of aortic valve stenosis:

246. Rheumatoid arthritis is:

247. For the treatment of rheumatoid arthritis, the basic drug is:

248. Which of the drugs affects the metabolism of uric acid?

249. Tofuses in patients with gout are located:

250. Typical radiological signs of osteoarthritis:

251. The leading pathogenetic mechanism of osteoarthritis progression is:

252. The main immune biomarkers of SLE include:

253. Lung injury in SLE is characterized by

254. What diagnostic method is important for dermatomyositis?

255. The main finding is thickening and tightening of the skin and inflammation and scarring of many body parts, leading to problems in the lungs, kidneys, heart, intestinal system and other areas.

256. A 43-year-old man’s body temperature increased to 38.3°C, there appeared sharp pains, swelling and redness of the thumb of the left foot. BMI=29 kg/m2. With increase in BP to 160/90 mm Hg, hydrochlorothiazid is taken by him. Most likely diagnosis is:

257. An 18-year-old patient has complaints of swelling, soreness and a local increase in temperature over the elbow joint on the right. Deterioration of the condition 2 weeks after a nasopharyngeal infection, volatility of joint pain. Your estimated diagnosis:

258. A 42-year-old woman in a hospital with complaints of pain in the joints of the hands and feet, elbow, knee joints, morning stiffness, weakness. From a history: she was ill for about 2 years, did not seen to the doctors. On physical examination: ulnar deviation of the hands; ulnar, knee without deformities; feet in the form of halux valgus. Your preliminary diagnosis:

259. A 51-year-old man was admitted to the hospital with complaints of prolonged pain and a feeling of bursting in his right hypochondrium. When examined: no jaundice, positive Ker's symptom, subfebrile temperature, ESR - 30 mm/h.

260. A 26-year-old man with complaints of temperature increase to 38°C, abdominal pain, loose stool up to 8-10 times a day with an admixture of blood and mucus. He has fallen ill acutely after SARS. Upon examination, the abdomen is moderately bloated, painful in the left iliac region, and the large intestine is palpated. What disease is most likely in the patient?

262. A 49-year-old man with complaints of a feeling of heaviness in his right underbelly, general weakness, weight loss, joint pain. He cannot specify an exact time of deterioration. On physical examination: jaundice, telangiectasias. On the inner surface of the elbow joints there are traces of injections. The liver protrudes from under the edge of the rib arc by 2.5 cm. The spleen is not palpable. Blood chemistry: total bilirubin-32.6 mmol/l. ELISA: Australian antigen detected. What is the diagnosis?

263. A patient, suffering from gastric ulcer for a long time, complained of weakness, nausea, loss of appetite, constant pain in the epigastric area, weight loss. In this case, you can think about:

263. A patient, suffering from gastric ulcer for a long time, complained of weakness, nausea, loss of appetite, constant pain in the epigastric area, weight loss. In this case, you can think about:

264. Patient A., 46 years old, plumber by profession, with complaints of abdominal enlargement, pain in the underarms, a sharp weight loss of 10 kg in 2 months. He has been ill for 3 years, when he first noticed the darkening of the skin. Deterioration of the condition during the last month, urine darkened, swelling appeared and the abdomen increased. Objectively: bronze-colored skin, ictericity of sclera, dark pigmentation of palm folds and soles, "vascular sprockets" on the chest, back and shoulders. Ascite. The liver and spleen are enlarged in size. What is your preliminary diagnosis?

265. A 57-year-old patient after a plentiful dinner at night had sharp pains in the area of thumb of his left foot, a temperature of 38°C. The examination revealed swelling of 1 st metatarsal-phalangeal joint, bright hyperemia of the skin around it. Touching the finger causes a sharp increase in pain. Your diagnosis:

266. Patient with complaints of pain in the joints of the hands and feet, morning stiffness, weakness. From anamnesis: ill for several years, not treated. Objectively: ulnar deviation of the hands, feet in the form of halux valgus. What is the preliminary diagnosis?

267. Patient Y., 32 years old, director of the company, went to the doctor with complaints of epigastric pain, worsening one hour after eating, without irradiation, poor appetite. From the anamnesis: SU (stomach ulcer) for 1.5 years. Abdomen: local muscle tension on the left in the epigastrium, moderate pain, the liver is not enlarged. On FGDS: the gastric mucosa is hyperemic and thinned in the pyloric section, where there is a mucosal defect 1 cm in diameter, rounded, with smooth edges, the bottom is covered with white fibrin. What is the diagnosis?

268. A young girl has discomfort when swallowing liquid food. These complaints for about a year, at work are often stressful. Recently, unpleasant sensations appear with unrest and fatigue. On examination, no pathology was found. What is the diagnosis?

269. A 28-year-old patient, unemployed, complains of poor appetite, epigastric pain, aggravated one hour after eating, without irradiation. History of SU for 3 years. On palpation of the abdomen: local muscle tension on the left in the epigastrium, moderate pain, the liver is not enlarged. The results of FGDS: the gastric mucosa is hyperemic and thinned in the pyloric section, where there is a mucosal defect with a diameter of 1.5 cm, rounded in shape, with smooth edges, the bottom is covered with white fibrin. What is the diagnosis?

270. As a variant of monotherapy for chronic gastritis type "B" use:

271. The driver of a vehicle complains of heaviness in the epigastric region, loss of appetite, nausea, belching with air. On FGDS: atrophy of the gastric mucosa. Urease test is positive. Preliminary diagnosis:

272. A 25-year-old patient suffered from acute dysentery 2 weeks ago. Complains of aching pain in the lower abdominal cavity, aggravated 6 hours after eating; diarrhea after taking dairy products. On colonoscopy: erosive changes, thinning and pallor of the mucous membrane against the background of an atrophic process. Which of the following diagnoses is the most likely?

273. At the reception, a 30-year-old patient complains of aching pain in the lower abdomen, which worsens 6 hours after eating; diarrhea after taking dairy products. On colonoscopy: the mucosa is pale, edematous, erosive changes, mucus, pus in the lumen. Which of the diagnoses is most likely?

274. At the reception, a 43-year-old patient complains of pain in the epigastric region, more on the right, frequent loose stools with mucus, weakness, general malaise, low-grade fever. On examination: the esophagus is freely passable. The mucous membrane of the esophagus is pale pink, loose. The cardia is passable, closes. In the lumen of the stomach is determined by a small amount of cloudy, foamy mucus. The mucosa is edematous, hyperemic, more pronounced in the antrum, tuberous. Symptom "cobblestone pavement", there are phenomena of inflammation. We pass the gatekeeper, closes. Bulb duodenum spherical shape. The mucosa of the 12th intestine is totally edematous, in some places eroded, hyperemia with multiple protrusions in the form of a "cobblestone pavement". What disease are you talking about?

276. At the reception, a patient, 42 years old, complains of pain in the epigastrium, more on the right, frequent loose stools with an admixture of mucus, weakness, general malaise, subfebrile temperature. On examination: the esophagus is freely passable. The mucous membrane of the esophagus is pale pink, loose. The cardia is passable, closes. In the lumen of the stomach is determined by a small amount of cloudy, foamy mucus. The mucosa is edematous, hyperemic, more pronounced in the antrum, tuberous. S-m "cobblestone pavement", the phenomenon of inflammation. We pass the gatekeeper, closes. Bulb duodenum spherical shape. The mucosa of the 12th intestine is totally edematous, in some places eroded, hyperemia with multiple protrusions in the form of a "cobblestone pavement". What disease are you talking about?

278. A 58-year-old patient who had been abusing alcohol for a long time, at the reception with complaints of jaundice of the skin and sclera, abdominal enlargement, headache, insomnia at night and drowsiness during the day. On examination: asterixis, "liver odor" from the mouth. Ultrasound of the abdominal cavity: signs of portal hypertension, hepatomegaly and splenomegaly, fluid in the abdominal cavity. Manifestations of which complication were diagnosed in this patient:

280. A 44-year-old patient at the reception complains of severe pain in the left hypochondrium, epigastrium, vomiting that does not bring relief, sharp weakness, frequent mushy stools, greasy with an unpleasant odor. Considers himself ill for many years. Deterioration after eating fatty foods. Chronic cholecystitis was diagnosed. Palpation of the abdomen is painful in the Hubergritz area, at the Mayo–Robson point. Symptoms of peritoneal irritation are negative. The most likely cause of the development of the disease in a woman is:

281. The patient is 44 years old, complains of severe pain in the epigastrium, repeated vomiting that does not bring relief, sharp weakness within 12 hours after the last meal. A history of alcohol use for many years. Deterioration after alcohol abuse for 3 days. On examination: Palpation of the abdomen is painful in the Shoffar, Hubergritz area, there is no muscle protection, symptoms of peritoneal irritation are negative. What disease is characterized by these changes?

282. A woman S., 52 years old, 3 years ago was diagnosed with chronic hepatitis B with an outcome of cirrhosis of the liver. During examination in blood tests: Hb-85 g/l, RBC-2.8x1012/l, WB-3.0x109/l, reticulocytes-2, PLT-130x109/l, ESR-22 mm/h, total protein-56 g/l, blood glucose-5.6 mmol/l, total bilirubin-46.3 mmol/l, unconjugated-12.4 mmol/l, conjugated-33.9 mmol/l, prothrombin index-78%, fibrinogen-2.9g/l, thymol-4 Units, ALT-0.70 mmol/l, AST-0.50 mmol/l. On ultrasound: The liver is enlarged, the echogenicity of the liver is increased. Portal vein 12 mm. The spleen is enlarged, the echostructure is homogeneous, the echogenicity is average, the splenic vein is 6.0 mm. There is no free liquid. Manifestations of hypersplenism in the patient are confirmed by the results of the examination:

283. The Child-Pugh score of the severity of liver cirrhosis is determined based on which indicators:

284. A woman, 50 years old, complaining of abdominal enlargement, hypochondrium pain, weight loss of 8 kg in 2 months. 7 years ago, chronic hepatitis C was detected when I first noticed darkening of the skin. Deterioration of the condition during the last month, increased the size of the abdomen. Objectively: dryness of the skin, icteric sclera, bronze-colored skin, enlarged convoluted subcutaneous veins on the chest. Ascites. The liver and spleen are enlarged in size, edema. During examination: hyperbilirubinemia due to direct fraction, hypoalbuminemia, increased ALT, AST, GGTP. On ultrasound: the contours are smooth, the size of the liver increases, the echogenicity of the liver is increased. The manifestations of portal hypertension syndrome are:

285. At the reception, patient S., 52 years old, complained of: itching, jaundice, pain in the right hypochondrium, weight loss, dark spots in the interscapular area and in the shoulder area. From anamnesis: 3 years ago, pigmentation appeared in the interscapular area and in the shoulder area. For 1 year, skin itching has been bothering. Ascites appeared this year. In the analyses: hyperbilirubinemia due to the direct fraction, a significant increase in alkaline phosphatase, GGTP. On ultrasound: changes in the structure of the liver. The most likely diagnosis:

286. A 35-year-old patient complains of short-term colicky pains in the right hypochondrium, with irradiation into the right shoulder blade, occur with errors in diet, strong emotions. Taking antispasmodics helps to relieve pain. Your diagnosis:

287. The patient is 39 years old, complains of severe pain in the epigastrium, repeated vomiting that does not bring relief, sharp weakness within 9 hours after the last meal. A history of alcohol consumption during the week. On examination: the condition is severe, the smell of alcohol from the mouth, lethargy, pallor of the skin and cold sweat. Blood pressure 80/50 mm Hg, heart rate 60 per min. Palpation of the abdomen is painful, there is no muscle protection, the symptoms of irritation of the peritoneum are negative. What is the presumed diagnosis?

288. A man 55 years old has been worried about shortness of breath during exercise, pain in the heart, in the interscapular region, swelling on the legs. She has been suffering from rheumatism for many years. Objectively: acrocyanosis, the boundaries of the heart are shifted up and to the right, 1 tone is amplified at the apex, diastolic noise at the apex, the rhythm of the "quail", atrial fibrillation. Radiography: the contrasted esophagus deviates in an arc of small radius. ECG: R-mitrale, right ventricular hypertrophy. Your diagnosis:

289. A 25-year-old patient complains of general weakness, fatigue. When a child, he was often ill with angina. Objectively: pulse is small, slow, carotid dance. During auscultation: attenuation of 1 tone at the apex of the heart and 2 tones on the aorta, systolic noise on the aorta and at the Erb's point; noise is better heard on the aorta, radiates to the carotid arteries and into the interscapular space. Your diagnosis:

290. The patient has shortness of breath during exercise, pain in the heart, swelling in the lower extremities. She has been suffering from rheumatism for a long time. Objectively: acrocyanosis, the boundaries of the heart are shifted up and to the right, 1 tone is amplified at the apex, diastolic noise at the apex, the rhythm of the "quail", atrial fibrillation. ECG: P-mitrale, right ventricular hypertrophy. Your diagnosis:

291. A 15-year-old teenager complains of swelling, soreness and a local increase in temperature above the knee joint on the right, before that the elbow joint was bothering. He had a sore throat 20 days ago. What is the preliminary diagnosis?

292. A 34-year-old patient went to the polyclinic, the general practitioner diagnosed rheumatoid arthritis. Which of the laboratory tests will be the most specific to confirm the diagnosis?

Patient R., 33 years old, complains of stiffness and pain in all joints during the day, an increase in body temperature to 37.5-38.00C, weight loss, periodic muscle pain. She has been ill for about 3 months. The deterioration of the condition is noted after childbirth, which proceeded without complications. Objectively: the joints of the hands are deformed, swollen, whiteness of the fingertips, pronounced swelling and deformation of the knee joints, movements in them are limited, atrophy of the interosseous muscles of the hands. Pathology of internal organs was not found. What is the most likely diagnosis?

294. A 47-year-old patient diagnosed with Rheumatoid arthritis has complaints of pain in the knee joints. Objectively: effusion in the knee joint on the left, there are no signs of visceritis and vasculitis, body temperature is normal, ESR-25 mm/ h. She has been ill for about 5 months, she has not been treated before. What are the tactics of treatment of this patient?

295. A 47-year-old patient suddenly had severe pain in the right foot at 7 a.m., then the pain was localized mainly in the area of the I-II metatarsophalangeal joints of the right foot. The skin is purple, hot to the touch, swelling spreads to neighboring soft tissues, palpation is sharply painful, movement and walking are almost impossible, body temperature is 37.6°C, headache. The day before he was at a party where he consumed meat in large quantities with alcohol. Diagnostic tactics of the doctor:

296. A 26-year-old man with a BMI=31 kg/m2, the day after the festive banquet complains of severe pain in the first finger of the left foot, change in skin color. What kind of arthritis does the patient have:

297. The patient complains of an increase in body temperature to 37.9oC, swelling and redness of the thumb of the right foot with sharp pains appeared. BMI=30 kg/m2. When blood pressure is increased to 155/90 mm Hg, he takes hypothyazid. Preliminary diagnosis://

298. A 65-year-old woman, there appeared stiffness and pain (lasting for ~15-20 minutes) when she first wakes up and after resting for prolonged periods. BMI=31 kg/m2. Most likely diagnosis is:

299. A 20-year-old patient has complaints of swelling, soreness and a local increase in temperature over the joints of the hands. Presence of antinuclear antibodies, positivity for anti-ds-DNA antibody, serum lymphocytopenia, and urine protein of 2.0 g/day. Your estimated diagnosis:

300. The man has a pronounced edematous syndrome, fever, joint and muscle pain. After the examination, the patient was diagnosed with systemic lupus erythematosus. Choose the right treatment strategy:

301. Autoimmune connective tissue disorder which is characterized by fibrosis of visceral organs, skin and blood vessels is….

302. What disease is characterized by the following symptoms? In most cases, the first symptom is a distinctive skin rash on the face, eyelids, chest, nail cuticle areas, knuckles, knees, or elbows. The rash is patchy and usually a bluish-purple color. A rash on the chest is known as a “shawl sign” because it appears in a shawl-like pattern. A rash on the hands is known as “mechanic’s hands“, because it makes the skin appear rough and dirty.

303. A 48-year-old woman, there appeared stiffness and pain in the knee joints (lasting for ~15-20 minutes) when she first wakes up and after resting for prolonged periods. BMI=30 kg/m2. What is the instrumental diagnostic method would you choose?

304. A 17-year-old patient has complaints of swelling, soreness and a local increase in temperature over the joints of the hands. Presence of serum lymphocytopenia, and urine protein of 2.0 g/day. What are immunological biomarkers are needed to determine the diagnosis?

305. A 53-year-old woman, there appeared stiffness and pain in the knee joints (lasting for ~15-20 minutes) when she first wakes up and after resting for prolonged periods. BMI=30 kg/m2. Choose the right treatment strategy:

306. A 39-year-old female patient. Decreased number of wrinkles were observed. Upper lip was insufficient to cover maxillary teeth, which is also known as “mouse-like face”. Anamnesis revealed that the patient had Raynaud phenomenon. What are immunological biomarkers are needed to determine the diagnosis?

307. A woman of 63 years old has been worried about pain in the left knee joint for the last 1.5 years when walking, which increases when going down the stairs. On examination, the right knee joint is slightly enlarged in size due to effusion. The skin above it is warmer than over the left knee joint. On knee joints X-ray, osteophytes are detected, equally on both sides. Make a diagnose:

308. On physical examination, a 54-year-old patient has the cyanotic blush on her face, the heart apex is shifted to the left, a weakening of the 1st tone is determined by heart auscultation, systolic murmur is heard at the apex of the heart immediately after the 1st tone, which is passed to the left axillary region, and the pathological 3rd tone is also heard. On ECG: signs of hypertrophy of the left atrium and left ventricle. Your diagnosis:

309. A 23-year-old patient complains of weakness, rapid fatigue. As a child, he was often suffered from sore throat. On physical examination: pulse decreased. In auscultation: attenuation of 1 tone at the apex of the heart and 2 tones on the aorta, systolic murmur on the aorta and at the Botkin-Erb point; murmur, radiates to the carotid arteries and to the intervertebral space. Your diagnosis?

310. A 48-year-old man works as a coach. He complained of an increase in body temperature to 38.3°, sharp pain, swelling and redness of the thumb of the left foot. During the year, a violation of purine metabolism is noted, treatment is not taken. Periodically he allows a diet violation. IMT=29,4 kg/m2. For the last week, due to an increase in BP to 160/90 mm Hg, he takes hydrochlortiazide. What was the provoking factor of deterioration?

311. A patient with rheumatoid arthritis has no fever, visceritis and vasculitis, there is effusion in the knee joints, ESR is 35 mm/h. The duration of the disease is 6 months, she has not been treated before. Select a treatment method:

312. A 35-year-old woman complains of body temperature up to 38-39 ° C, volatile pain, swelling and limitation of movement in the knee, ankle, wrist joints for 2 years, overall weakness, loss of body weight (7 kg in 6 months); On physical examination: lymphadenopathy, hepatosplenomegaly. Joints X-ray: epiphyseal osteoporosis, narrowing of joint slots. CBC: WBC-3.6x109/l, segmented neutrophils-35%, lymphocytes-53%, ESR-44 mm/h. Blood biochemistry: CRP-7 mg/l, fibrinogen-5.9 g/L. Rheumatoid factor-17 IU/ml. Which of these medicines are most suitable for treatment?

313. During the doctor’s examination, a 43-year-old patient complains of pressing pains in the epigastrium after eating, periodically burping. In esophagogastroduodenoscopy (EGD) chronic gastritis was diagnosed, a helicobactor pylori were detected. Which medicine is recommended to prescribe to the patient?

315. A 60-year-old patient works as a loader at the reception. During the examination for FGDS, it was revealed that the esophagus is freely passable. Cardia closes. The folds of the cardia and the body of the stomach are smoothed, deformed. The mucosa is uneven, loose, brightly hyperemic. In the region of the pylorus, a protrusion along the back wall of a dark purple color bleeds on contact, a biopsy was taken. The lumen is closed in the form of a slit, with difficulty straightening, the mucosa of the 12th intestine is hyperemic, loose, pasty. The lumen is not fully expanded. Your diagnosis and tactics: