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).                                                                                                                 

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4. What is your first priority for the nursing care of this patient? Why?                          

                                               

Answer 1

(a) The likely cause of vomitting bright red colored blood is BLEEDING FROM ESOPHAGEAL VARICES ,which develops when the portal circulation is blocked.

(b) LIVER CIRROHSIS is the underlying cause of all the symptoms the patient had presented with.

Vomitting blood, Swollen abdomen, Gynaecomastia are all symptoms of Liver cirrhosis. Here the reason for developing liver cirrhosis is chronic drinking.

(c) Liver cirrhosis   Portal hypertension Rupture of arteries( GI bleeding) Hematemesis .

Liver cirrohsis Portal hypertension Ascites( swelling in abdomen) .

Chronic drinking  Increased production of female sex hormone, estrogen Gynaecomastia.

( d) The nurse should give priority care to treat blood loss as the patient had vomitted blood for 30 minutes. Severe blood loss can lead to confusion, shock or even coma.