CASE 1
ANSWERS:
1. Upper GASTROINTESTINAL BLEEDING
2. Risk factors: Age, Usage of NSAIDS , Chronic smoker, diagnosed recently with heart attack.
3. Diagnostics workup: Recommend the following diagnostics for Mr. AC:
1. Complete Blood Count (CBC): This test can help assess for any signs of anemia or infection.
2. Coagulation Profile: To evaluate the blood’s ability to clot properly and rule out any bleeding
disorders.
3. Stool Occult Blood Test: This test can detect hidden blood in the stool and help determine the
source of the gastrointestinal bleeding.
4. Upper Endoscopy: This procedure allows for direct visualization of the upper gastrointestinal tract
to identify any bleeding sources.
5. Colonoscopy: To examine the colon and rectum for any potential sources of bleeding.
6. Electrocardiogram (ECG): To assess the heart’s electrical activity and check for any cardiac
abnormalities.
7. Imaging Studies: Depending on the clinical findings, imaging such as a chest X-ray or
echocardiogram may be recommended.
4 ans) Ans. Black tarry stool, also known as melena, is a result of upper gastrointestinal bleeding.
When there is bleeding in the upper digestive tract, such as the esophagus, stomach, or small
intestine, the blood mixes with stomach acid and digestive enzymes. This interaction causes the
blood to undergo chemical changes, leading to the black color and sticky consistency of the stool.
The main mechanism behind this process is the breakdown of hemoglobin, the protein responsible
for carrying oxygen in red blood cells. When blood comes into contact with stomach acid and
enzymes, the iron in hemoglobin undergoes a chemical reaction called oxidation. This oxidation
process transforms the iron into a compound called ferric sulfide, which gives the stool its
characteristic black color.
It's important to note that black tarry stool can be a sign of serious underlying conditions, such as
peptic ulcers, gastritis, or gastrointestinal bleeding. If someone experiences this symptom, it’s
crucial to seek medical attention promptly for further evaluation and appropriate treatment.
5ans)
CASE 2
1 ANS) Gallbladder-related issues: Mrs. BD’s symptoms, such as right upper abdominal pain, nausea,
vomiting, and pain radiating to the right scapula, could be indicative of gallbladder problems like
gallstones or cholecystitis.
2. Pancreatitis: The sudden onset of abdominal pain after eating a fatty meal, along with nausea,
vomiting, and pain radiating to the back, could be suggestive of pancreatitis.
3.Peptic ulcer disease: The abdominal pain, especially if it worsens after eating, along with nausea and
vomiting, could be associated with peptic ulcer disease.
4. Gastrointestinal obstruction: The colicky pain, nausea, vomiting, and worsening symptoms after
eating could be indicative of a gastrointestinal obstruction.
2 ans) 1. Onset after eating a fatty meal: Mrs. BD experienced sudden onset of abdominal pain 45
minutes after eating a three-layer hamburger, which suggests a possible connection to gallbladder
function.
2. Radiating pain to the right scapula: The pain spreading to the right scapula is a characteristic
referred pain pattern associated with gallbladder problems.
3. Inspiratory arrest upon subcostal palpation of the RUQ: This finding, along with increased pain,
could be indicative of Murphy’s sign, which is commonly associated with acute cholecystitis.
To make the diagnosis more definitive, additional expected findings could include:
1. Elevated liver enzymes: Blood tests may reveal elevated liver enzymes, such as alanine
aminotransferase (ALT) and aspartate aminotransferase (AST), which can indicate gallbladder or
liver involvement.
2. Imaging studies: Ultrasound or other imaging modalities may be performed to visualize the
gallbladder and identify any gallstones or signs of inflammation.
3. Fever and chills: These symptoms, along with the worsening pain, could indicate an infectious
component to the gallbladder problem.
3 Ans) Ans. Black tarry stool, also known as melena, is a result of upper gastrointestinal bleeding.
When there is bleeding in the upper digestive tract, such as the esophagus, stomach, or small
intestine, the blood mixes with stomach acid and digestive enzymes. This interaction causes the
blood to undergo chemical changes, leading to the black color and sticky consistency of the stool.
The main mechanism behind this process is the breakdown of hemoglobin, the protein responsible
for carrying oxygen in red blood cells. When blood comes into contact with stomach acid and
enzymes, the iron in hemoglobin undergoes a chemical reaction called oxidation. This oxidation
process transforms the iron into a compound called ferric sulfide, which gives the stool its
characteristic black color.
It's important to note that black tarry stool can be a sign of serious underlying conditions, such as
peptic ulcers, gastritis, or gastrointestinal bleeding. If someone experiences this symptom, it's crucial
to seek medical attention promptly for further evaluation and appropriate treatment.
4 Ans) The pathophysiology of gallbladder-related conditions, such as acute cholecystitis, typically
involves the formation of gallstones. Gallstones can develop due to imbalances in the components
of bile, including cholesterol, bile salts, and bilirubin. When these substances become concentrated,
they can form solid particles that gradually grow into gallstones.
Possible causes and predisposing factors for gallstone formation and gallbladder conditions include:
1. Obesity: Excess body weight is a significant risk factor for gallstone formation. Obesity can lead to
increased cholesterol levels in the bile, contributing to stone formation.
2. Female gender: Women are more prone to developing gallstones compared to men, likely due to
hormonal factors.
3. Age: Gallstones are more prevalent in older individuals, as the gallbladder function and bile
composition change with age.
4. Rapid weight loss: Losing weight too quickly, especially through crash diets or bariatric surgery,
can increase the risk of gallstone formation.
5. Family history: Having a family history of gallstones or gallbladder disease can increase the
likelihood of developing these conditions.
6. Certain medical conditions: Conditions like diabetes, liver cirrhosis, and certain blood disorders
can increase the risk of gallstone formation.
7. Prolonged fasting or total parenteral nutrition: Not eating for extended periods or receiving
nutrition through an intravenous line can reduce gallbladder contractions, leading to bile stasis and
stone formation.
5 ans) Treatment:
Medical therapy: extracellular volume depletion and electrolyte abnormalities are repaired, and
analgesia is provided. Intravenous antibiotic therapy is indicated in patients with severe acute
cholecystitis, even though bacterial superinfection of bile may not have occurred in the early stages
of the inflammatory process. . Effective antibiotics include piperacillin plus tazobactam, imipenem,
meropenem, ceftriaxone plus metronidazole, and levofloxacin plus metronidazole
Surgical therapy:
Urgent (emergency) cholecystectomy or percutaneous cholecystostomy is probably appropriate in
most patients in whom a complication of acute cholecystitis such as empyema, emphysematous
cholecystitis, or perforation is suspected or confirmed. Patients with uncomplicated acute
cholecystitis should undergo early elective laparoscopic cholecystectomy, ideally within 48–72 h
after diagnosis. early cholecystectomy (within 72 h) is the treatment of choice for most patients with
acute cholecystitis.
