Topic: pathology and clinical science
LOOKING AT TWO CASE STUDIES AND ANSWERING the given questions in relevance to them. Giving references to back up questions answered. The two topics are Renal Stones and gastroesophageal reflux disease (GORD) and peptic Ulcer. Word count needs to be 750-1000 words for each case study. each case study needs to have 5 quality references ie: reference textbooks, research papers no older than 8years, academic websites. No wikipedia. Case studies are attached. harvard referencing with specific page numbers please.
CASE STUDY 1 (25 MARKS) Word Count: 750 – 1000 words
Michael is a bioscientist who travels frequently to deliver seminars on his latest research. He has presented to hi GP complaining of stabbing pain in the epigastrium and discomfort in his chest, which he says has been getting worse over the past three months. This discomfort increases after meals, especially if he eats fatty or spicy food. These cause a burning sensation in the epigastric region, bloating and dyspepsia. Because of his frequent travelling, he admits that his eating habits are pretty irregular.
His symptoms started about 5 months ago with discomfort in the abdomen and recurrent flatulence and disturbed sleep. This situation progressed gradually, and has exaggerated over the past month.
Michael always feels hungry and there is an empty feeling in his stomach about 2-3 hours after a meal. This is usually accompanied by a gnawing pain in the upper stomach area which is relieved by further eating or a glass of milk. Sometimes he is nauseated, that is unrelieved by belching. After meals he regularly has the sensation of the food regurgitating back up into the throat . Investigations:
Vital signs: Test Result Normal range Blood pressure 145/90 (110-130/70-80) mm of Hg (for this age group) Pulse rate 92 per minute 60-100 per minute Respiratory rate 18 breaths / minute 12-16 breaths per minute Temperature 36.9 ˚C 36.6 – 37.2 ˚C
Haematology: Test Result Normal range Haemoglobin 105 gms/L (140-160) gms/L Hematocrit 28 36 – 49 Mean Cell Volume (MCV) 66 fl 76 – 100 Mean Cell Haemoglobin (MCH) 21 pg 27 – 32 pg Fasting blood sugar 4.4 mmol/L 3.6 – 5.3 mmol Platelets 420 (x10 6 /L) 150-400 (x10 6 /L)
Endoscopy: revealed three small solitary white patches surrounded by an area of redness in the pylorus and a solitary lesion in the proximal part of duodenum, measuring between 1 and 2 cms in diameter, as indicated in the images below.
Questions: Answers: 1) List all the signs and symptoms from the given case study in terms of their location, onset, progress and duration. 2) Outline three possible conditions for Michael. 3) Briefly explain the haematology test results for Michael. 4) What would be the expected findings if a physical examination of Michael’s abdomen was conducted? 5) What further investigative tests would you like to order? Explain how these tests can help the diagnosis? 6) Describe the changes taking place in the mucosal cells in Michael’s pylorus and duodenum to explain the pathophysiology of his condition. 7) Select one of your differential diagnoses. What are the conventional treatments used for this condition? 8) How would you manage this case apart from the treatment?
SaveDate 23 July 2014 Page 4 of 5 CASE STUDY 2 (25 MARKS) Word Count: 750 – 1000 words A fifty year old man, who lives in the outback, presents to the ‘mobile’ GP clinic with haematuria, frequency and burning while urinating. He also complains of bilateral loin pain, radiating down into his groin. He has lived in the outback for all of his adult life, and his only water supply is bore water from the underground aquifer. The GP takes some urine for culture and sensitivity along with a sample for ‘dip-stick’ testing. He also takes blood for a Full Blood Count, and the results are below. He also takes an abdominal x-ray on a very old, but still functional, x-ray machine, and the x-ray image is below. Full Blood Count: Haematology: Test Result Normal range Haemoglobin 115 g/L (115-160) g/L White cell count 12,000 (X10 6 /L) 4000 – 11000 (X10 6 /L) Packed cell volume 0.37 0.37 – 0.47 Platelets 410 (X10 6 /L) 150-400 (X10 6 /L)
Endeavour College of Natural Health Student No. © Endeavour College of Natural Health 472bb42f0c1e48c4bd623bdb54ec04a7 SaveDate 23 July 2014 Page 5 of 5 a) When considering his symptoms, list two findings on a urine ‘dip-stick’ that you would expect to discover in this patient, and what is the rationale for these findings.
b) From the x-ray above, it is clear that this man has renal calculi. What type of calculi is visible in this X-ray, and name two types of mineral deposits that can produce such calculi?
c) Apart from the symptoms that this man has presented with, describe three additional clinical signs and symptoms of renal calculi.
d) Explain four (4) causes of renal calculi.
e) The region that this man comes from in central Australia, is a desert land and has very hard water. Explain how the geographical location of may have contributed to the development of his renal stones. What could he do to help prevent a recurrence of calculi in the future.
f) What is the likely course of treatment for this patient?
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