Reference no: EM133422896

Assignment:

This is an 84-year-old female with a history of coronary artery disease, and is complaining of increasing fatigue for several days and near syncope (fainting) prior to admission. She states "I just didn't feel like I could stand up anymore". In addition, she has had some melanotic (darkly colored) stools. She denies any abdominal pain. She has had some mild nausea without emesis (vomiting). She denies any chest pain, any orthopnea (shortness of breath while lying down), paroxysmal nocturnal dyspnea (sporadic shortness of breath during the night) or edema. She has a long-standing history of osteoarthritis treated with aspirin and other NSAIDS as needed. The patient gives no prior history of GI disease, nor a family history of such. She does not give any personal history of cancer or family history of such.

Medications are one coated aspirin per day, Atenolol (beta 1 receptor blocker), and Imdur (vasodilator).

1. In the emergency department she is found to have a hemoglobin of 6.1 mg/dl (nl = 12-15 mg-dl), hematocrit of 18.3% (nl = 38-45%), RBC count of 2.5 x 1012/L (normal = 3.8-5.2 x 1012/L) normal WBC and platelet counts, negative troponin and CK, basically normal renal panel and stool strongly guaiac-positive (blood present in stool). BP = 120/80, respiratory rate 20 (slightly high), pulse 80 and regular (normal). She is afebrile (without fever).

2. In this particular patient, explain the physiology behind why she felt fatigued and like she was going to faint. Be very explicit in your physiological explanation.