Question

VanMeter: Gould's Pathophysiology for the Health Prefessions, 5th Edition Chapter 17: Digestive System Disorders Case Studies Case Study 1 Ms. F, 48 years old, has been admitted to the hospital with severe abdominal pain. Earlier that day she had generalized abdominal pain, followed by a severe pain in the lower right quadrant of her abdomen, accompanied by nausea and vomiting. That evening she was feeling slightly improved and the pain seemed to subside somewhat. Later that night, severe, steady abdominal pain developed, with vomiting. A friend took her to the hospital, where examination demonstrated lower right quadrant tenderness and mild abdominal rigidity Fever and leukocytosis indicated infection. A diagnosis of acute appendicitis, with possible perforation, was indicated, with immediate surgery 1. Why is the sequence of pain (location and type of pain) significant in the diagnosis of acute appendicitis? Describe the rational for each type of pain. Does this sequence confirm the diagnosis? (See Appendicitis.) :2. Using the pathophysiology, describe the reason for: a. the pain subsiding and then recurring. b. leukocytosis and fever. c. abdominal rigidity. (See Appendicitis Pathophysiology, Signs and Symptoms.) 3. Discuss the complications that might arise from rupture of the appendix. (See Appendicitis-Pathophysiology.) Case Study 2 Mr. V is a 55-year-old alcoholic who checked into a clinic, complaining that he has been experiencing a persistent cough and feeling more fatigued, nauseous, and iritable. In addition, he is experiencing more frequent memory lapses. His stomach is distended, but on palpation, his lver is small in size and firm, indicating cirrhosis. Lab tests indicate a decrease in hemoglobin, albumin, and prothrombin levels with elevated serum bilirubin and ammonia levels. 1. Describe the various stages through which Mr. V's liver has progressed and the implications of the current stage. (See Cirrhosis-Alcoholic Liver Disease.) 2. Provide a specific rationale for each of Mr. V's manifestations and blood values. (See Alcoholic Liver Disease Pathophysiology, Signs and Symptoms.) 3. a. Is it possible to reverse the damage to the liver at this stage? What is the b. Choose four significant complications that are likely to occur, and discuss the predisposing factors and effects on the liver. (See Pathophysiology and Treatment.)

Answer 1

CASE STUDY 1

1. Appendicitis , most common cause of acute abdomen and also most common cause of emergency abdominal surgery. The appendix is a small finger like appendage about 4 inches attached to caecum right below caecal valve. The appendix gets inflamed and edematous as a result of either becoming kinked or occluded by a fecalith, tumor or any foreign body. The inflammatory process increases the intraluminal pressure , initiating a progressive , severe form of generalized or upper abdominal pain that becomes localized in the right lower quadrant of the abdomen (Mcburney's point)within a few hours.

Generalized abdominal pain followed by severe pain in the right lower quadrant of abdomen accompanied by nausea and vomiting: Inflammed appendix causes nausea, vomiting, low grade fever , loss of appetite and generalized pain.

At night severe steady abdominal pain with vomiting: Severe steady pain is the sign of ruptured appendix .

2. a. The pain subsides when the inflamed appendix ruptures which decreases the pressure temporarily.Again the pain recurs steadily and severely in abdomen due to developing peritonitis.

b.The inflammed appendix after rupture may accomodate toxins and micro organisms .As result of infection leucocyte increases exceed 10,000cells/cu.mm and neutrophil exceeds 75% along with fever of 37.7 degree celsius or even higher.

c.Vague epigastric or periumbilical pain progresses to right lower quadrant . Rebound tenderness may be present.( Guarding sign may be felt during palpation of abdomen).Lower portion of rectus muscle becomes rigid.

3.Major complication mansifested after appendicitis is perforation of the appendix , which ends up into peritonitis or an abscess. Perforation generally occurs 24 hours after onset of pain . Perforated appendix when not treated at correct time may even lead to death.