Case 4: Gastrointestinal system An 83-year-old man is brought to the emergency room with acute abdominal pain. He has had intermittent episodes of burning/gnawing epigastric pain a few times a year, lasting three to four weeks at a time. The pain usually begins one to two hours after eating and is often relieved by eating. Three hours prior to the patient's evaluation in the ED, he reported an abrupt increase in sharp diffuse abdominal pain and nausea. He subsequently passed out at home and was found by family member. He has been self-treating with antacids and bland diets. The patient underwent an upper gastrointestinal endoscopy one year earlier which demonstrated a 7mm ulcer in the duodenal bulb and moderate antral gastritis. Antral biopsy at the time showed active chronic gastric due to Helicobacter pylori. He takes aspirin for osteoarthritis. Over the last month the patient has also been taking ibuprofen for joint pain relief. He smokes a pack of cigarettes per day and drink 5-6 beers per day. On examination, his blood pressure is 92/63, heart rate 135, respiratory rate 34. He is pale, diaphoretic, and quite uncomfortable. Bowel sounds are absent and the abdomen is distended on inspection; increased abdominal tympany is noted diffusely on percussion. Hepatic dullness is absent. The abdomen is diffusely tender and rigid; rebound tenderness is present. The patient is lying still on the bed as movement seems to worsen his abdominal pain. Initial Laboratory Studies WBC-18,600 (4,000-11,000) Hemoglobin - 16.8 gm/DI (13-16.5) Amylase - 520 U/L (20-60) Flat & upright abdominal X-rays: evidence of scattered small bowel air-fluid levels, free air below the right hemidiaphragm.
Case 4: Gastrointestinal system An 83-year-old man is brought to the emergency room with acute abdominal pain. He has had intermittent episodes of burning/gnawing epigastric pain a few times a year, lasting three to four weeks at a time. The pain usually begins one to two hours after eating and is often relieved by eating. Three hours prior to the patient's evaluation in the ED, he reported an abrupt increase in sharp diffuse abdominal pain and nausea. He subsequently passed out at home and was found by family member. He has been self-treating with antacids and bland diets. The patient underwent an upper gastrointestinal endoscopy one year earlier which demonstrated a 7mm ulcer in the duodenal bulb and moderate antral gastritis. Antral biopsy at the time showed active chronic gastric due to Helicobacter pylori. He takes aspirin for osteoarthritis. Over the last month the patient has also been taking ibuprofen for joint pain relief. He smokes a pack of cigarettes per day and drink 5-6 beers per day. On examination, his blood pressure is 92/63, heart rate 135, respiratory rate 34. He is pale, diaphoretic, and quite uncomfortable. Bowel sounds are absent and the abdomen is distended on inspection; increased abdominal tympany is noted diffusely on percussion. Hepatic dullness is absent. The abdomen is diffusely tender and rigid; rebound tenderness is present. The patient is lying still on the bed as movement seems to worsen his abdominal pain. Initial Laboratory Studies WBC-18,600 (4,000-11,000) Hemoglobin - 16.8 gm/DI (13-16.5) Amylase - 520 U/L (20-60) Flat & upright abdominal X-rays: evidence of scattered small bowel air-fluid levels, free air below the right hemidiaphragm.
Chapter17: Drugs And Dissection
Section: Chapter Questions
Problem 1CP
Related questions
Question
Expert Solution
This question has been solved!
Explore an expertly crafted, step-by-step solution for a thorough understanding of key concepts.
Step by step
Solved in 5 steps
Recommended textbooks for you
Comprehensive Medical Assisting: Administrative a…
Nursing
ISBN:
9781305964792
Author:
Wilburta Q. Lindh, Carol D. Tamparo, Barbara M. Dahl, Julie Morris, Cindy Correa
Publisher:
Cengage Learning
Comprehensive Medical Assisting: Administrative a…
Nursing
ISBN:
9781305964792
Author:
Wilburta Q. Lindh, Carol D. Tamparo, Barbara M. Dahl, Julie Morris, Cindy Correa
Publisher:
Cengage Learning
Essentials of Pharmacology for Health Professions
Nursing
ISBN:
9781305441620
Author:
WOODROW
Publisher:
Cengage
Basic Clinical Lab Competencies for Respiratory C…
Nursing
ISBN:
9781285244662
Author:
White
Publisher:
Cengage