Question

Chief Complaint: 74-year-old woman with shortness of breath and swelling. History: Martha Wilmington, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she's had a decreased appetite, some nausea and vomiting, and tenderness in the right upper quadrant of the abdomen. On physical examination, Martha's jugular veins were noticeably distended. Auscultation of the heart revealed a low-pitched, rumbling systolic murmur, heard best over the left upper sternal border. In addition, she had an extra, "S3" heart sound. Top of Form

5. You examine Martha's abdomen and find that she has an enlarged liver ("hepatomegaly") and a moderate degree of ascites (water in the peritoneal cavity). Explain these findings. 6. Examination of her ankles reveals significant "pitting edema." Explain this finding. 7. She is advised to wear support stockings. Why would this help her? 8. Which term more accurately describes the stress placed upon Martha's heart -- increased pre-load or increased afterload? 9. What is the general term describing Martha's condition? 10. How might Martha's body compensate for the above condition? 11. Martha is started on a medication called digoxin. Why was she given this medication, and how does it work? 12. Two weeks after starting digoxin, Martha returns to the physician's office for a follow-up visit. On physical examination, she still has significant hepatomegaly and pitting edema, and is significantly hypertensive (i.e. she has high blood pressure). Her physician prescribes a diuretic called furosemide (or "Lasix"). Why was she given this

Answer 1

Question no 5

Martha has ascitis and hepatomegaly.

Hepatomegaly is the condition where the liver become enlarged

Ascitis is the situation where the fluid will move out of the blood vessel into abdomen and cause enlargement of the abdomen

The cause in this case is her congestive heart failure that result in the right side heart failure and reduced return flow of blood to heart . The main cause of ascitis is the portal hypertension die to right side heart failure .

Question no 6

Pitting edema is the condition where the fluid in blood vessels move out to the interstitial space in body. On examination if a pit is formed when 2 fingers are pushed in the body area where edema occur then if small pit is formed it is pitting edema.

Question no 7

Wearing stockings can help in the increase of return flow of blood from extremity and also prevent complications like deep vein thrombosis.

Question no 8

Increase preload as the rightside failure has occured and it will result in the increase in retention if fluid and increase the preload