DB 3 Pathophysiology

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Herzing University *

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621

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Mechanical Engineering

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Jan 9, 2024

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Pathophysiology DB 4 Case #1 : A 64-year-old man presents to the emergency department with abdominal pain and distention, as well as constipation of 8 days’ duration. He denies vomiting, fever, diarrhea, or dysuria. Except for hypertension, he is otherwise healthy with no prior surgeries. His vital signs are normal except for a borderline pulse of 99 bpm. His physical examination is unremarkable except for his abdomen, which is large, rotund, and tympanitic. There is diffuse tenderness everywhere in the abdomen. What history would you want to obtain? The discomfort due to abdominal pain is unbearable thus must have felt so miserable at home for those 8days. Daily, 15% of Americans experience constipation, which increases with age, affecting approximately 34% of women and 26% of men 65 years and older (Downey, 2022). Thus, patients with constipation are associated with a higher risk of stroke, coronary heart disease, and all-cause mortality (Downey, 2022). As a healthcare personnel, when assessing this individual, I would ask about his diet because if he has not been eating fruits, vegetables, drinking enough water (8 to 16 ounces), it results in constipation. I will also obtain the abdominal pain level on a scale of 0-10. The intensity of the pain will determine what pain medication to be ordered and administered. Additionally, I will find out the duration of the pain since he has been dealing with the pain for 8days, still considered acute pain, so finding out if had any surgical procedure, especially in the abdomen can help determine the diagnosis. Also, is important to ascertain whether the patient had surgery recently and what kind of pain medication he is taking, because pain medications cause constipation. Inquiring about the location or radiation of the pain is very crucial for it will enable knowing if the pain occurs in one position or moves around. Encouraging the patient to describe the pain helps determine whether the pain is aching, nauseating, shooting, dull, twisting, stabbing, throbbing, burning, stretching, crushing, or sharp. Obtaining these histories from the patient will impel me to recognize the diagnoses. What differential diagnoses would you consider? While analyzing the patient’s signs and symptoms which are constipation, distention, and abdominal pain, it indicates that the patient has ischemic colitis or small intestinal obstruction. Small bowel obstruction (SBO) for more than 75% of the whole gastrointestinal tract and 90% of its mucosal surface (Caio et al., 2019). In the US population, 5300 new cases of SBO are discovered, and 1100 deaths per year (Caio et al., 2019). Small bowel obstruction (SBO) is caused by postoperative adhesions (66%), tumors, Crohn's disease, hernias, and intussusception. SBO leads to distention caused by impaired absorption and increased secretion with the accumulation of fluid and gas inside the lumen proximal to the obstruction (McCance & Huether 2019). List and describe the specific diagnostic tests you might order to determine the cause of his concern. I will order multi-detector CT, Serological testing, and lab works like CBC, and CMP. Hence, I will be checking on the results of the lipases, magnesium, potassium, lactic acids, and calcium. Serological testing was based on the detection of tissue transglutaminase (tTGA) and anti- endomysia (EmA) antibodies of the IgA class(Gitonga & Shen, 2021). Also, the multi-detector CT-scan (MDCT) is used to diagnose SBO. Thus, the most specific MDCT findings or key

features concerning adhesive IH include clustering or crowding of intestinal segments, crowding of mesenteric blood vessels, kinking or angulation of bowel loops, bowel wall thickening, presence of a hernia orifice, and the fat notch sign (Gitonga & Shen, 2021). Also, SBO can be managed by administering intravenous antibiotics, resuscitating fluids, and performing surgery related to the underlying cause of the perforation (McCance & Huether 2019). References Caio, G., Volta, U., Ursini, F., Manfredini, R., & De Giorgio, R. (2019). Small bowel adenocarcinoma as a complication of celiac disease: clinical and diagnostic features. BMC Gastroenterology , 19 (1), N.PAG. https://doi.org/10.1186/s12876-019-0964-6 Downey, M. (2022). Banish Constipation and Its Health Risks. Life Extension , 28 (8), 38–44. Gitonga, E. N., & Shen, H. (2021). Small bowel obstruction and strangulation secondary to an adhesive internal hernia post ESWL for right ureteral calculi: a case report and review of literature. BMC Gastroenterology , 21 (1), 1–4. https://doi.org/10.1186/s12876-021-01760-2 Kathryn L. McCance, Sue E. Huether. (2019). Pathophysiology: the biologic basis for disease in adults and children. St. Louis: Mosby Rajakumar, A., Appuswamy, E., Kaliamoorthy, I., & Rela, M. (2021). Renal Dysfunction in Cirrhosis: Critical Care Management. Indian Journal of Critical Care Medicine , 25 (2), 207–214. https://doi.org/10.5005/jp-journals-10071-23721

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