CASE STUDY 32.2A 65-year-old man presents to the emergency department after he hadabnormally tarry-colored stool on multiple occasions. He has hadgastrointestinal discomfort and has felt increasingly tired during the past 2months. Physical examination reveals a guaiac-positive stool. Asubsequently colonoscopy identified a circumferential mass in the sigmoidcolon. A biopsy was performed, which identified the mass as anadenocarcinoma. CEA level was obtained as part of the presurgery workup.questions1. Is the CEA test useful as a screening test for colon carcinoma?2. What other conditions can result in elevated CEA levels?3. How is CEA used to monitor patients after surgery for colon cancer?

CEA (Also known as Carcinoembryonic antigen) It is a substance present on surface of some cells. It…

Answered: A 65-year-old man presents to the…

Phlebotomy Essentials

6th Edition

ISBN:9781451194524

Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Chapter1: Phlebotomy: Past And Present And The Healthcare Setting

Section: Chapter Questions

Problem 1SRQ

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Case study: Constipation and pharmacological management of peptic ulcer A 75-year-old female patient has visited the clinic with a presenting history of not having had a bowel movement for four days. She states that she is ‘always regular or every day. She lives in a residential home and suffered a sprained ankle two weeks ago, for which she has been taking co-codamol, which has been effective in managing the pain. She admits that the injury has restricted her movements, and she has been unable to ‘get about’ as she usually does. She also reveals that she has been experiencing heartburn regularly, especially after a spicy meal or after a glass of whisky, which she sometimes takes to help her to relax since the injury. She has been taking an antacid for the last few days, which initially helped, but she is still experiencing indigestion. She has a past medical history of hypertension and persistent atrial fibrillation (AF), for which she takes digoxin 125micrograms od, aspirin 75mg od,…
A 16-year-old nonsmoker teenager was admitted to the outpatient clinic complaining of a 14-month history of postprandial vomiting that progressed into hematemesis the last week. The patient was suffering from fatigue, dysphagia related to solid food, and loss of appetite which led to weight loss; the body mass index (BMI) dropped from 27.7 kg/m2 to 16.3 kg/m2 during this period; before that, the patient had been seeing many clinics outside the country without any conclusive diagnosis. Clinical examination revealed a pale-colored skin with mild jaundice, and the abdomen did not show any palpable mass (hepatomegaly, splenomegaly, and enlarged lymph nodes), tenderness, or rebound tenderness. The remainder of the physical examination was unremarkable. A lower esophageal sphincter narrowing was found by an upper gastrointestinal endoscopy (UGE) corresponding with a fragile bleeding gastric mass; that prevented from taking a biopsy. CT studies supported these findings by determining a large…
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R.T. is a 64-year-old man who went to his primary care provider's office for a yearly examination. He initially reported having no new health problems; however, on further questioning, he admitted to having developed some fatigue, abdominal bloating, and intermittent constipation. His physical examination was normal except for a stool positive for guaiac. R.T. was referred to a gastroenterologist for a colonoscopy. A 5-cm mass found in the sigmoid colon was diagnosed as an adenocarcinoma of the colon. The pathology report described the tumor as a Dukes’ stage B, meaning cancer extends into the muscle or connective tissue and invades adjacent organs and lymph nodes. A distant metastatic workup is negative, and R.T. is being referred for surgery. Vital Signs BP: 148/82, R: 89, R: 20, T: 99° F .Lab Results: CBC wnl, BMP wnl and carcinoembryonicantigen (CEA) 4.7 Medications: Morphine IV, leucovorin (folinic acid) 10 mg IM, and irinotecan (Camptosar) injectionMarcia Clinical…
Answer with reference sir please
A 32 yr old female presented to your office complaining of abdominal pain. She states this pain started yesterday and increased over the course of a couple of hours. It is mostly in the epigastric region and does radiate at times to the RUQ. She states it has been constant since then. Currently rates it at a 7/10. She has never had pain like this before. Denies any vomiting but does complain of nausea. She denies any diarrhea or constipation. Denies any documented fevers but has felt a little chilled this am. Denies any abdominal bloating. She does state she drinks a glass of wine each evening. Denies any tobacco use or street drug use. Current labs WBC 13.2 Hgb 14.0 Hct 38.9 Plt 250 Na 142K 4.0BUN 26CR 1.2Total bilirubin 2.5 mg/dl AST 289 ALT 302Alk Phos 358 What does the AST/ALT ratio indicate for this patient What if your AST/ALT ratio were >1. What would that suggest?
please i need help, only have 2 hours left
Case ScenarioThe patient is a 54-year-old Caucasian male with ulcerative colitis who underwent a totalproctocolectomy with end ileostomy in 1997. He developed a parastomal hernia that was becomingincreasingly symptomatic. Following a discussion with the patient regarding the risks and benefits of parastomal hernia repair, he underwent an exploratory laparotomy with enterolysis, parastomal herniarepair and re-siting of the ileostomy. The hernia defect was repaired primarily with a biologic meshunderlay (Alloderm, Lifecell®). He received one preoperative dose of cefoxitin; consistent withpreoperative antibiotic guidelines. The operation was uneventful. His postoperative course wasuncomplicated; on postoperative day 4 he was tolerating a regular diet and had normal ileostomy output.He was subsequently discharged home.Twenty-four hours later, he returned to the hospital emergency department with complaints ofabdominal pain and feculent vomiting. Vital signs on arrival were notable for a…
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Case ScenarioThe patient is a 54-year-old Caucasian male with ulcerative colitis who underwent a totalproctocolectomy with end ileostomy in 1997. He developed a parastomal hernia that was becomingincreasingly symptomatic. Following a discussion with the patient regarding the risks and benefits of parastomal hernia repair, he underwent an exploratory laparotomy with enterolysis, parastomal herniarepair and re-siting of the ileostomy. The hernia defect was repaired primarily with a biologic meshunderlay (Alloderm, Lifecell®). He received one preoperative dose of cefoxitin; consistent withpreoperative antibiotic guidelines. The operation was uneventful. His postoperative course wasuncomplicated; on postoperative day 4 he was tolerating a regular diet and had normal ileostomy output.He was subsequently discharged home.Twenty-four hours later, he returned to the hospital emergency department with complaints ofabdominal pain and feculent vomiting. Vital signs on arrival were notable for a…
. S is a 48 YO F who recently had an esophagoduodenoscopy (EGD) that showed a lesion and a narrowing of the distal esophagus just above the lower esophageal sphincter. A biopsy was taken that proved to be positive for squamous cell adenocarcinoma. Mrs. S was admitted to the hospital for more tests with a plan for possible surgery. Her height is 5’6” with weight of 148 lbs on admission. Her UBW (usual body weight) was 175 lbs. Mrs. S’s physician decided to initiate chemotherapy in an attempt to shrink the tumor prior to surgery. The physician also consulted the surgical dietitian in order to start TPN as the patient could not swallow or have an enteral feeding tube placed due to the tumor. He ordered D5NS at 50 ml/h until the TPN was started. Calculate the total calories from protein and lipid. How many kcals will be needed from carbohydrate based on the patient’s total calorie requirement? How many grams of carbohydrate will be needed to meet the patient’s needs? Assume…

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