Reference no: EM133933758
Description
Mr. Franklin is a 60-year-old patient with a history of a thrombotic cerebrovascular accident two years ago. After the stroke he started with seizure attacks. He has been suffering from hypertension for the last ten years and ulcerative colitis since last year. He currently takes lisinopril, hydrochlorothiazide, aspirin, carbamazepine, and a low dose of prednisone.
Mr. Franklin has been suffering from epigastric pain, sensation of fullness, and occasional nausea for the last six months. This time, he was brought to the ER because, while he was talking to his son, he had a dizzy spell and fell to the floor. He is conscious and is complaining of severe epigastric pain. He began with mild abdominal pain two days after he started taking a new cycle of prednisone for his colitis, around seven days ago. The pain increases when he eats or drinks something. He is also complaining of suffering from pyrosis, malaise, and dizziness, and he has noticed that his feces are dark.
The patient was a heavy alcohol drinker until he had the stroke. He is a cigarette smoker since he was 20 years old. His mother suffered from Alzheimer's disease and died of colon cancer, and his father died of cirrhosis of the liver.
On physical examination we found:
Remarkable Signs on Physical Exam by Regions
Abdomen: Pain on palpation on epigastric region
SOMA: Right hemiplegia and hyperreflexia
Remarkable Signs on Physical Exam by Systems
Integumentary system: Pallor, diaphoresis, coldness
Cardiovascular system: Tachycardia. Blood pressure 70/50 mmHg. Radial pulse 110.
Digestive system: Tenderness of epigastric region. Rectal exam showed melena.
Neurologic system: The patient is conscious and well oriented to time, place, and person. Right hemiplegia and hyperreflexia.
Lab Tests
Complete blood count (CBC)
Metabolic panel
Lipid panel
Abdominal CT scan
Esophagogastroduodenoscopy
Main Diagnosis
Upper digestive bleeding due to drug-induced gastritis
Hypovolemic shock
Acute anemia
Other Diagnoses
Stabilized thrombotic cerebrovascular accident
Epilepsy
Essential hypertension
Ulcerative colitis
1. What organs are included in the upper digestive system? Mention and explain at least three other conditions of the upper digestive system that may be a cause of digestive bleeding.
2. What specific sign on the physical exam is characteristic of upper digestive system bleeding?
3. What organs are included in the lower digestive system? What are some causes of lower digestive system hemorrhages, and how do you differentiate them from upper digestive system hemorrhages?
4. According to the patient's previous medical history, it is possible that he has cirrhosis of the liver? Why? Can cirrhosis of the liver be a cause of upper digestive bleeding? What is the prognosis? Explain.
5. Are there any specific risk factors of diseases of the gallbladder or pancreas? If so, why, and what is the prognosis?