BMB 420 Lecture 4: Case with Rumbly Tummy

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February 4, 2019
Case Study: The Man with the Rumbly Tumbly
Dr. Jones 47 years
o Nausea unease discomfort in upper gastrointestinal tract
o Dyspepsia - indigestion
o Epigastric pain - ~1 month; pain localized to upper abdomen
o One prior occasion of hematemesis vomiting blood
Smoked approximately 1-2 packs a day, smoked for 15 years, quit 10 years ago
A social drinker liver problems possibly
No particular food intolerance
Does not drink coffee ulceration in stomach caused by degrading mucous and epithelial cell
which causes blood vessels in connective tissue to leak blood > blood in stomach
Liberally uses aspirin for pain aspirin can cause stomach ulcers as well
Additional questions to ask: have you traveled recently? Changes in diet? Immunocompromised,
HIV, etc? Family histories? Receiving treatment for antibitotics? Recent long-term
hospitalizations? Pets and animals?
Why after a month of pain, why did he come to doctor office?
o Awaken in night with severe abdominal pain
o Threw up coffee ground looking material
o Dark tar stools melenic stool
Indicates bleeding in upper intestinal tract (before smaller intestine)
If bloody in stool - occurred in lower intestinal tract
Possible Tests to Run: fecal streak, blood test, upper intestinal endoscopy, MRI, vomit testing,
o MRI regular normal
o Blood test protein levels increased, but no change from normal
o Urinalysis specific gravity increased, but otherwise normal
o Fecal testing see nothing
o Vomit testing good idea of what's going on
o Pink is good, shiny is good
o Red splotchy bleeding
o Pale dehydrated, ULCER = exposed layers under eptihelium
o Gastric pits in mucous layer acid secretion > can erode epithelial layer
o Mucousa , eptihelial layer, connective tissue, submucousa., muscularis mucosae,
muscularis externa
o Ulcers need treatment, do not resolve on own
When you spot ulcer, we should do a biopsy....
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