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Other than acting to flex the spine and compress the abdominal contents, the abdominal muscles are extremely important in protecting and containing the abdominal viscera. What is it about the arrangement of these muscles that makes them so well suited for their job?

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Trinidad Tremblay
Trinidad TremblayLv2
28 Sep 2019

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Question 21

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Carbohydrate intolerance is a rare but very serious hereditary disorder. Cases due to lack of digestive enzyme and to impaired hexose transport have been reported. It is estimated that glucose-galactose malabsorption accounts for 2% of the patients with protracted diarrhea of infancy. In two reported cases of glucose-galactose malabsorption, the infants developed diarrhea soon after birth. Their stools contained reducing sugars and had an acidic pH. Analysis of tissue obtained by biopsy of the small intestine showed normal villi with normal disaccharidase values. Monosaccharide feeding (loading) tests showed a normal rise in blood glucose following a fructose load dose, which was tolerated well. This result was in contrast to a flat glucose curve in response to a glucose load, which was accompanied by marked abdominal distension, profuse diarrhea, and the presence of reducing sugars in the stools.

What is a reducing sugar? Why would it be increased in these patients?

Which monosaccharide transport protein is lacking in these patients? Give a rationale for your answer.

If the plasma glucose concentration had been monitored in these two patients following a load of sucrose, would a rise in plasma glucose have been observed? Give a rationale for your answer.

In terms of plasma glucose concentration, what would have been observed following a loading dose of lactose?

What would be an appropriate dietary treatment for these individuals?

Based on the following case study respond to these questions:

1. The patient in our case study, Mr. Franklin, had dizziness and was found on the floor. What traumatic brain injuries do we have to rule out?

2. How do we clinically know if the patient was having a seizure attack?

3. Is it probable that he has a new cerebrovascular accident? Explain

4. What risk factors does Mr. Franklin have of suffering from dementia in the future?

Personal Information

Name: Mr. Christopher Franklin

Age: 60 years old

Gender: Male

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, a 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 by Regions

Abdomen: Pain on palpation on epigastric region

SOMA: Right hemiplegia and hyperreflexia

Remarkable Signs on Physical by Systems

Integumentary system: Pallor, diaphoresis, coldness

Cardiovascular system: Tachycardia. Blood pressure 70/50 mmHg. Radial pulse 110.

Digestive system: Tenderness of epigastric region. A 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

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