Mrs. B.N. is 67 years of age and has had a long history of arthritis, which is t

Question

Mrs. B.N. is 67 years of age and has had a long history of arthritis, which is treated with anti-inflammatory medication. Her doctor has prescribed a drug to protect her stomach, but the drug is very expensive. She has chosen to take the "arthritis pills" without the "stomach pills" because her stomach feels fine. Recently she has had indigestion, which is relieved some-what by eating. She also noticed hard, black tarlike stools. The indigestion becomes very painful and she vomits several times one morning. She is weak and lies down to rest, but her nausea and vomiting continue. When her heart begins to beat as though it "is trying to run away with me," she calls a friend to take her to the hospital. She is examined and a diagnosis of acute gastritis and irregular heartbeat is made. Treatment is started. What fluid and electrolyte imbalances can be caused by vomiting? How are these imbalances related to Mrs. B.N.'s irregular heartbeat? Mrs. B.N. has experienced an irregular heartbeat that reduces cardiac output and may cause blood to pool in the atria of the heart. What are two potential problems that Mrs. B.N. may experience from the altered function of the heart? What has caused the change in Mrs. B.N.'s stools and what potential problem can occur if this continues?

Explanation / Answer

This is the case of enteropathic arthritis where patient has inflammation of some part of the digestive tract with arthritis. However, Mr B.N. was not feeling the inflammation but it develops sudden and cause for acute gastritis.

1. During vomiting, he loosens ions like chloride, sodium, potassium, magnesium, calcium, and bicarbonates. The heart requires persistent action potential to make heartbeats. If body loss the ions like potassium, sodium, and calcium, which play the most important role in creating action potential, the pacemaker of heart will make disturb potential and hence it causes to produce irregular heartbeats.

2. The irregular heartbeat has made by arthritis especially Rheumatoid and its drugs though COX-2 inhibition pathway disruption. By the irregular, heartbeat, patient can have abnormal contraction in heart. It may cause heart block if persistent.

3. She had black stool due to presence of blood through acute inflammation in digestive tract.

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