Question

A 56-year-old male patient is brought in by ambulance after vomiting bright red blood for the last 30 minutes. On examination the patient has a swollen abdomen and gynaecomastia. His partner, when questioned, mentions that the patient has been a chronic drinker for the last 15 years.

1. What is the likely cause of the patient vomiting blood?                                                       (1 mark)
2. What is the underlining cause of all the symptoms the patient has presented with? (1 mark)
3. Explain the pathophysiology of each of the symptoms the patient has presented with in relation to the diagnosis in (b).                                                                                                                 
4. What is your first priority for the nursing care of this patient? Why?                           

Answer 1

a. Alcoholics more prone to have esophageal veins swollen and ruptured which is called esophageal varices which is characterized by blood in vomitings

b. The underlying cause of all the symptoms is liver damage due to chronic alcoholism.

C. Due to the etiological factors like alcoholism the patient may show inflammatory changes of liver and it will further progress in to fibrosis and eventually cirrhosis

Cirrhosis leads to portal hypertension which cause arterial vasodilation leads to reduction in effective arterial volume and it caused activation of vasoconstriction system and finally it leads to ascites

d. The first priority for this patient is to prevent infection and circulatory problems because bleeding can occur and leads to hypovolemia, and bacterial infections are common cause for morbidity and mortality as patients with cirrhosis are immunocompromised and high susceptible for infections