Digestive System Case Study #1
| Question # 41782 | Biology | 4 years ago |
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| $12 |
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Digestive System Case Study #1
History of Present illness
Harry H. is a 45-year-old
man who has abused alcohol his entire adult life. Recently, following an episode of binge
drinking, Harry experienced a gradual onset of pain in his upper abdomen that
radiated to his back. The pain persisted
for several hours and worsened each time that he ate. He also felt nauseous and experienced
repeated episodes of vomiting during the last 3 days. The pain grew more intense and Harry decided
to drive himself to the emergency room of Calvert Memorial. The physician who examined Harry in the ER
noted the following findings when she performed a physical exam - Intense pain
upon palpation of the upper left quadrant of the abdominal cavity, gaseous
distension of the intestinal tract, and tachycardia.
The physical exam findings, together with the history of alcohol abuse and the results of a CBC, serum chemistry panel, and abdominal ultrasound, led the physician to immediately initiated the appropriate medical therapy
Patient Medical History
Angioplasty 1 year ago; denies any chest pain since
Appendicitis
Cholecystectomy
(+) for Hepatitis C x 5 years
Social History
Married with 4 children
Alcohol abuse with 10-12 cans of beer per day for 15 years
Denies use of tobacco or illicit drugs
Review of Systems
States that he has been feeling “verv warm” and has experienced several episodes of nausea and vomiting during the past 72 hours.
Also describes an approximate 8-10 pound weight loss over the past 1 ½ months
He has noted a reduction in frequency of bowel movements
No complaints of diarrhea or blood in the stool
No knowledge of any previous history of poor blood sugar control
Physical Exam and Lab Tests
General
The patient's age appears to be consistent with that reported. He seems restless and in acute distress. He is sweating profusely and appears ill. He is bent forward on the examiner’s table.
Vital Signs
BP 85/60, Pulse 120
RR 35 T 101.4°F
HT 5'8’ WT 154 lbs
Blood Test Results
Na 134 meq/L
Monos 2%
K 3.5 meq/L
Eos 1%
Cl 99 meq/L
AST 291 IU/L
HCO3 25 meq/L
ALT 161 IU/L
Creatinine 1.5 mg/dL
Alkaline Phos 266 IU/L
Hb 18.3 g/dL
LDH 411 IU/L
Hct 53%
Amylase 1874 IU/L
Glucose fasting 415 mg/dL
Lipase 2119 IU/L
WBC 16,400/mm3
Triglycerides 971 mg/dL
Neutros 73%
Ca 8.3 mg/dL
Bands 3%
Mg 1.7 mg/dL
Lymphs 20%
PO4 2.4 mg/dL
Questions for you to answer:
1. Based on the patient's history of illness, what is your diagnosis
2. Identify three risk factors that may have predisposed this patient to your diagnosis.
3. Identify two abnormal lab test that suggest that acute renal failure has developed in this patient.
4. Why are the hemoglobin (Hb) and hematocrit (Hct) abnormal?
5. Does the patient have a significant electrolyte imbalance?
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