Question

Mr. Franklin is a 60-year-old patient with a history of a thrombotic cerebrovascular accident two years ago. After the stroke he started with seizure attacks. He has been suffering from hypertension for the last ten years and ulcerative colitis since last year. He currently takes lisinopril, hydrochlorothiazide, aspirin, carbamazepine, and a low dose of prednisone.

Mr. Franklin has been suffering from epigastric pain, sensation of fullness, and occasional nausea for the last six months. This time, he was brought to the ER because, while he was talking to his son, he had a dizzy spell and fell to the floor. He is conscious and is complaining of severe epigastric pain. He began with mild abdominal pain two days after he started taking a new cycle of prednisone for his colitis, around seven days ago. The pain increases when he eats or drinks something. He is also complaining of suffering from pyrosis, malaise, and dizziness, and he has noticed that his feces are dark.

The patient was a heavy alcohol drinker until he had the stroke. He is a cigarette smoker since he was 20 years old. His mother suffered from Alzheimer's disease and died of colon cancer, and his father died of cirrhosis of the liver.

• Abdomen: Pain on palpation on epigastric region
• SOMA: Right hemiplegia and hyperreflexia
• Integumentary system: Pallor, diaphoresis, coldness
• Cardiovascular system: Tachycardia. Blood pressure 70/50 mmHg. Radial pulse 110.
• Digestive system: Tenderness of epigastric region. Rectal exam showed melena.
• Neurologic system: The patient is conscious and well oriented to time, place, and person. Right hemiplegia and hyperreflexia

Respond to the following?

1. According to the patient's previous medical history, it is possible that he has cirrhosis of the liver? Why? Can cirrhosis of the liver be a cause of upper digestive bleeding? What is the prognosis? Explain.
2. Are there any specific risk factors of diseases of the gallbladder or pancreas? If so, why, and what is the prognosis?
3. What specific sign on the physicals is characteristic of upper digestive system bleeding?

Answer 1

1)From the history collection we know that the patient was chronic alcoholic for 20 years. Alcoholism is one of the major risk factor for alcoholic liver cirrhosis. In alcoholic cirrhosis the liver become stiff, swelling and finished. So the normal function of liver is impaired .

The one of the complications of liver cirrhosis is esophageal varices rupture .This is the cause for upper GI bleeding. This occurred due to the blood flow to the liver is blocked and accumulation of blood in portal vein happened. This will lead to portal hypertension. For compensating this blood accumulation the blood is passed to the small and narrowed veins of the upper GI system that is near to the lower portion of esophagus. This will lead to increase pressure in that narrowed veins and will easy to rupture. This will result in upper GI bleeding. The prognosis is poor. If we can control bleeding only 26% have survived for 5 years.

2)from the above medical history it is clearly states that the patient is chronic drinker and chronic use of alcohol cause chronic pancreatitis.pancreatitis is a condition that referred as inflammation of the pancreas. This will affect hormone production and digestion . The symptoms are upper abdominal pain radiate to back, nausea, vomiting, tenderness ,steatorrhea etc.

Prognosis is based on age and health conditions .The average survival rate is 70% for 10 years and 45% for 20 years.

3)from the physical examination we notice the presence of Malena. That is passing of blood through stool. This is the major signs for upper GI bleeding of bleeding present in GI tract.