Online Cases 3-25-11 Fri. 2

Online Cases 3-25-11 Fri. 2 - O nline Cases Friday ASH...

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Online Cases 3-35-11 Friday - ASH Hematemesis I. HISTORY PATIENT PRESENTATION A 64-year-old man who has not seen a doctor for 25 years presents to the emergency department after four episodes of vomiting over the past two days. He describes the vomitus as looking like coffee grounds. What symptoms or history might be helpful in making the diagnosis? Consider each of the following and click on the information you believe will be most helpful for making a diagnosis. Abdominal discomfort Good choice! COMMENT: Coffee ground emesis is suggestive of upper gastrointestinal bleeding which may be associated with abdominal pain if due to gastritis or peptic ulcer disease. PATIENT RESPONSE: The patient denies any abdominal pain. Abnormal bleeding or easy bruisability Good choice! COMMENT: Coffee ground emesis is suggestive of upper gastrointestinal bleeding. PATIENT RESPONSE: The patient denies bleeding but does report easy bruisability of his arms and legs. Alcohol intake Good choice! COMMENT: Alcohol consumption can cause cirrhosis which leads to decreased synthesis of clotting factors. Cirrhosis can also lead to increased pressure within the portal venous system, which can cause esophageal varices. Alcohol can cause gastric irritation leading to gastritis or peptic ulcer disease. Finally, repeated vomiting can lead to mucosal tears in the esophageal mucosa which can bleed. These are called Mallory-Weiss tears. PATIENT RESPONSE: The patient admits to drinking one-fifth of rum daily for over 10 years. Early satiety Good choice! COMMENT: Early satiety can indicate the presence of splenomegaly, which can be a sign of liver cirrhosis. PATIENT RESPONSE: The patient denies early satiety. Family history Not important in this case. Fatigue or shortness of breath Good choice! COMMENT: Fatigue and shortness of breath can be signs of anemia. This might indicate that the degree of blood loss is severe. PATIENT RESPONSE: The patient denies both fatigue and shortness of breath. Fever Good choice! COMMENT: Nausea and vomiting can be due to viral infections. PATIENT RESPONSE: The patient denies fever. History of jaundice Good choice! COMMENT: Patients with liver disease can have episodes of jaundice related to inability of the liver to conjugate and excrete bilirubin. PATIENT RESPONSE: The patient denies a history of previous jaundice.
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History of liver disease Good choice! COMMENT: Patients with liver disease can have upper gastrointestinal bleeding from gastritis, peptic ulcer disease, or varices. PATIENT RESPONSE: The patient denies any known history of liver disease. HIV risk factors Good choice! HIV risk factors may be linked to risk factors for hepatitis C. PATIENT RESPONSE: He denies any HIV risk factors. Immunizations
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Online Cases 3-25-11 Fri. 2 - O nline Cases Friday ASH...

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