Question

Biology

DB (2-3 pages)

1)A 56-year old man had a total gastrectomy. A year later, he is found to be anemic. Explain the pathophysiology of this case in detail.
2)Describe the post-operative management and advice for a patient who just underwent a renal transplant.
3)Draw the total innervation of the tongue on a diagram. Indicate the different areas of taste.

Answer 1

1) The pathophysiology in this case is :

Complications of post-gastrectomy syndrome include anemia as a result of vitamin B12 or iron malabsorption and osteoporosis. These problems generally occur months or even years after gastric surgery. Vitamin B12 malabsorption occurs when a protein known as intrinsic factor is either not produced by the stomach (this is a condition called pernicious anemia) or when the proximal stomach is resected (the portion of the stomach that produces intrinsic factor). In either case, that absence of intrinsic factor leads to the poor absorption of vitamin B12. Under normal circumstances intrinsic factor binds to vitamin B12 and assists with the absorption of this vitamin in the lower portion of the small bowel. When vitamin B12 is poorly absorbed, anemia and, in some cases, poor nerve function can occur. This generally does not happen for several years because vitamin B12 is stored in large amounts in the liver.

Iron deficiency anemia develops because removal of the stomach often leads to a marked decrease in the production of gastric acid. This acid is necessary to convert dietary iron to a form that is more readily absorbed in the duodenum. Anemia usually does not occur for a few years after gastric surgery because iron is stored in moderately large amounts in the bone marrow, where red blood cells are produced.

2) The post operative management and advice for a patient who just underwent a renal transplant are :-

- Monitoring vital signs , level of consciousness

- Monitoring renal function

- Strict input and output charting

- Assess for signs of infection

- Advice to avoid too many visitors to avoid infecion

- Advice to avoid boques , flowers , raw foods , etc to avoid infection

- Advice to take home made or hospital food only no junk foods

- Teach the patient about the signs of rejection and when to reach the hospital

- Teach and encourage the patient for turning , coughing and deep breathing exercises .

- Assess the incision site for wound closure and provide wound care to avoid infection

- Advice to maintain compliance to the medicines

- Provide psychological and emotional support

3.

nnervatuos O (bl 、Internal Palatogloaus CN X merve henue CN XII Hetr Nesives Senary

TASTE ON TONGuE BITTER SouR- SAEET