Reference no: EM133582076

Question 1. L.B. is a 45-year-old Caucasian woman with three children-ages 4, 6, and 10 years. She works long hours as an instructor at a local college to support her three children and husband who is disabled. She has had a 6-month history of severe bouts of abdominal pain associated with indigestion, gas, and steatorrhea. Fatty foods seem to exacerbate the symptoms. L.B. is about 40 pounds overweight. A CT scan of L.B.'s abdomen revealed multiple stones in her gallbladder. She was scheduled for a cholecystectomy.

1. What risk factors does L.B. have that predispose her to development of gallstones?

2. Why are fatty foods often associated with an exacerbation of symptoms?

3. What is the relationship between gallstones and cholecystitis?

4. What options are there for the surgical removal of the gallbladder? What other options are available for the treatment of cholecystitis?

4. Laparoscopic cholecystectomy is selected. Will L.B. continue to secrete bile after her surgery? How?

Question 2. F.C. is a 54-year-old man with a history of chronic heavy alcohol use. He has frequent bouts of gastrointestinal bleeding for which he has been hospitalized on six separate occasions over the years. He continues to drink and exhibits most of the common manifestations of alcoholic cirrhosis. He was recently hit by a car and was hospitalized for a broken leg. He appeared to be under the influence of alcohol at the time of the accident and had a blood alcohol level of 1.8. F.C.'s family reports that his mental functioning has deteriorated significantly over the past few months.

1. What are the common manifestations of alcoholic cirrhosis? Which of these are secondary to hepatocellular failure? Which are secondary to portal hypertension?

2. Why is F.C. at particular risk for GI bleeding?

3. What is the probable cause of F.C.'s progressive mental deterioration? How might his mental deterioration be medically managed?

4. What problems might be precipitated by F.C.'s abrupt cessation of alcohol intake while hospitalized?

Question 3. Mr. Sander is 67 years old with a long history of knee osteoarthritis for which he self-medicates regularly with over-the-counter (OTC) naproxen. He is in the clinic today complaining of a swallowing difficulty that has progressively worsened over the past several months. He has otherwise been healthy and has not seen a doctor in many years. He denies significant past medical history. A review of systems is negative except for arthritic symptoms and swallowing difficulty. He denies noticing blood in his stool or vomiting blood. He denies history of gastroesophageal reflux disease (GERD)
or ulcer. He does not drink alcohol, although he drank heavily many years ago. He does not smoke. The dysphagia is described as "food gets stuck in my throat and I can't get it down." The feeling occurs only after he has ingested solid food; liquids are not a problem. There is burning chest pain associated with meals. He is scheduled for an upper GI endoscopy.

1. What is the likely cause of the dysphagia?
2. What advice should he be given regarding his OTC medication at this time?
3. What are the usual signs and symptoms of GERD? How will it be managed?