PAC3421 Lecture Notes - Lecture 26: Abdominal Pain, Diarrhea, Chemotherapy

A 35-year old accountant presented to his physician with a steady burning pain just right of the mid-line of the of the abdominal region in an area from 1 to 4 inches above the "belly button." The pain usually followed meals by about 1-3 hours. He had several episodes of vomiting, which included frank blood. On physical examination, the patient had no fever. He appeared generally well. He had no evidence of weight loss. He showed slight rebound tenderness in the upper abdomen. An occult blood test revealed the presence of blood. What would your diagnosis in this case be? What organism is most likely to be responsible for these symptoms and findings? What further testing and treatment are called for?

Case-3: Patient History

T.J. is a 46-year-old science professor brought to urgent care this afternoon by his wife. T.J. has been at home for 3 days with severe diarrhea and vomiting. His youngest daughter was hospitalized earlier in the week with similar symptoms. T.J. has no significant medical history and takes no medications. Examination reveals an ill-appearing, pale, diaphoretic man who is having difficulty concentrating and answering questions. He has diffuse abdominal pain. Vital signs are as follows: Lying—HR 100, BP 100/80, resp 26, temp 100. Sitting—HR 136, BP 90/60. He has not urinated since yesterday morning.

Analyze this case study and answer the next three questions that follow.

Case-3: Question-1

What other laboratory or clinical data would be helpful in assessing T.J.’s fluid-electrolyte and acid-base status? (select all that apply)

Case-3: Question-2

Which assessment data should be monitored during fluid replacement therapy to determine when adequate volume has been restored? (select all that apply)

Case-3: Question-3

How might persistent vomiting and diarrhea alter acid-base balance? (select all that apply)

Dale Fremore was back home after spending the day at a picnic where he ate some "spoiled" potato salad. He developed severe abdominal pain and cramps, vomiting, and diarrhea. After about 10-12 episodes of watery diarrhea, Mr. Fremore became so pale and weak he could hardly walk. His wife took him to the hospital where he was diagnosed with severe dehydration (decreased plasma volume). Mr. Fremore was suffering from shock. Explain what happens to cardiac output, urine output, pulse pressure and blood pressure of Mr. Fremore. Would the respiratory system be affected and if so, how? Would the immune system be activated, why or why not? Answers must be to the cellular level