Pathophysiological Analysis of Disease - Case Study Example

Pathophysiology of Disease Order No. 269545 No. of pages: 8 1st 6530 Medical history and clinical information A 54-year old construction worker was referred to casualty. He had suffered a bout of haematemesis following lifting heavy beams. On examination, he was found to be 10 kg underweight, a little dehydrated and confused. The liver was firm and enlarged, and there was some pedal C on admission, and pulse was rapid and'oedema. His temperature was 42 irregular. There was also a history of alcohol abuse. The construction worker was rushed immediately to the emergency and a quick assessment was made. The person was in a semi- conscious condition, but taking into consideration all the above facts of the person who had suffered a setback due to Haematemesis, we are able to understand that the individual was getting on in age and the pressure of his job was more than he could handle. By looking at his given weight, we come to know that according to his BMI he was found to be underweight by about 10 kgs, in addition to being dehydrated, proving that he was not in a fit condition for the strenuous job of lifting heavy beams which resulted in a bout of Haematemesis. Haematemesis Hematemesis is the vomiting of blood usually from the upper gastrointestinal tract. This usually occurs if a person has the history of excessive alcohol abuse. In the case of our patient, upon examining it was found that the vomiting was incessant and was an upper gastrointestinal bleeding, showing that he had Haematemesis. To stop the bleeding from the esophagus immediately, the patient was treated with the Sengstaken- Blakemore tube (Bruno Feneyrou, MD, 2006) to put an end to the massive bleeding. The hemorrhage was brought under control. Causes In Hematemesis the person suffering would experience vigorous retching which causes the small blood vessels to tear in the area of the esophagus or throat. Other causes are irritation in the throat or stomach, bleeding from ulcers located in the esophagus, or stomach. Sometimes vomiting could take place due to ingested blood after hemorrhage from the nose or throat. At times, vomiting can take place due to vascular malfunction of the gastro intestinal tract, tumors or gastroenteritis. Laboratory Assessment The patient was prepared for the laboratory assessment to be made. Samples of the patient's blood, urine and faeces were taken for examination and tests were conducted. The following is the laboratory report given by the examiner. The following laboratory tests were requested. Laboratory investigation Test Values Reference values Serum Sodium 152 mmol l-1 (132 - 144) Potassium 3.1 mmol l-1 (3.2 - 4.8) Chloride 91 mmol l-1 (98 - 108) Urea 2.8 mmol l-1 (3.0 - 8.0) Bilirubin 85 'mol l-1 (< 20) Total Protein 50g l-1 (65 - 80) AST (aspartate transaminase) elevated ALP (alkaline phosphates) elevated Blood Haemoglobin 10.2g dl-1 (12.5 - 16.0) Haematocrit 40 mmol l-1 Urine Initial specimen tea coloured Protein strongly positive Glucose negative Faeces Admission smear Positive for blood Stool specimen Positive for blood Patient Assessment Every patient is unique and hence the treatment varies from patient to patient. The treatment of approach is more on a "personalized and comprehensive" (Roger Weiss, MD) level. After an initial assessment was made and the patient diagnosed for Haematemesis, he was taken in for a more detailed check up and assessment, so the right treatment could be administered. The patient was found to otherwise be hemodynamically stable, while blood, fluids and electrolyte resuscitation was administered. On admission the patient was found to have temperature which was 42'C, but the fever was soon taken care of through antibiotics. On further examination it was found that due to a history of alcoholic abuse, and in addition to the strain caused by strenuous work, the patient had developed 'gastrointestinal bleeding." (Kelly JJ, 2005) The pulse of the patient was rather erratic rapid and irregular. The patient was not found to be diabetic, hypersensitive, or asthmatic but nevertheless suffered from a progressive weight loss and malaise which had brought on the illness. Laboratory tests were conducted for serum to check the Sodium, potassium, chloride, urea, Bilirubin and total protein. The total levels of bilirubin had an elevation of 85 'mol l-1 which was quite high. Aspartate Transaminase, Alanine Transaminase, Alkaline Phosphatase were quite elevated. (at 289 iu/L, 93 iu/L and 68 iu/L respectively (normal being: Read More