Practical 2 – Anatomy & Physiology II Case 1 A 28-year-old graduate student comp

Question

Practical 2 – Anatomy & Physiology II Case 1 A 28-year-old graduate student complains of chronic heartburn that intensifies when lying in bed. The condition became prevalent during his qualifying exams five years previously and has recurred as he is approaching his final thesis defense. The patient had been taking omeprazole (Prilosec™) to manage the symptoms of acid reflux. The doctor first asks the patient to wean off of the proton pump inhibitor (Prilosec™), but the patient reports that previous attempts led to recurrence of heartburn when he went to bed. She decides to run tests to determine the source of the reflux and first orders upper GI radiography (barium swallow).

Case 2 During a screening colonoscopy for a 40-year-old man, the doctor discovers a flat cancerous polyp in the transverse colon. Histopathology of the removed polyp indicated that cancerous cells were present in the margin, suggesting that some of the polyp remained behind in the colon. The doctor ordered an abdominopelvic CT scan and blood work, including liver function and a hematocrit. A surgical consult is recommended based on results of CEA test from the blood work.

Case 3 A 49-year-old white female presents with a cough (producing yellow-green sputum) that has been going on for 3 days. She has labored breathing even under slight exertion. History: The patient is hypertensive and is being treated with metoprolol tartrate (a beta-blocker). She had a urinary tract infection a month previously and was treated with ciprofloxacin (200 mg, three times daily for 5 days). The patient has a 35-year history of smoking a pack per day, but has no evidence of obstructive respiratory disease. Vitals: BP 100/50 HR 108bpm temp: 39oC labored breathing during rest (32 breaths/min) rales (abnormal sounds) from left lung chest X-ray indicates infiltration of upper and lower lobes of the left lung

Case 4 A 42-year old banker was encouraged to go for a PSA test by his brother who was diagnosed with prostate cancer at 48. Results: PSA level: 5.6ng/mL Digital exam: asymmetrically firm prostate on the right Ultrasound: prostate volume of 32 cc; Bone scan: no evidence of metastasis

Explanation / Answer

Case 1: The chronic heartburn that intensifies when lying in bed indicates acid reflux, a typical sign of GERD.

Gastro esophageal reflux disorder (GERD) is a physiological abnormality in which the acidic contents of stomach reflex into esophagus. The causes of GERD include weakened lower esophageal sphincter, impaired acid clearance in the stomach due to unhealthy food habits and pregnancy, infection with H.pylori and stress. Heart burn and acid indigestion are the common symptoms of GERD.

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