While on tour, a 32-year-old male musician has presented to the ...

[LCritchfi]

While on tour, a 32-year-old male musician has presented to the emergency department of a hospital after a concert complaining of severe and sudden abdominal pain.
 
  He admits to a history of copious alcohol use in recent years, and his vital signs include temperature 46.8 C (101.8 F), blood pressure 89/48 mm Hg, and heart rate 116 beats/minute. Blood work indicates that his serum levels of C-reactive protein, amylase, and lipase are all elevated. Which of the following diagnoses would the care team suspect first?
  A)
  Hepatitis C
  B)
  Cholecystitis
  C)
  Liver cirrhosis
  D)
  Acute pancreatitis

Question 2

Following several days of intermittent upper right quadrant pain, a 29-year-old obese, Native American woman has been diagnosed with cholelithiasis.
 
  The nurse at the clinic has taught the client about the pathophysiology and contributing factors to her health problem, as well as some of the likely treatment options. Which of the following statements by the client demonstrates a sound understanding of her diagnosis?
  A)
  All in all, I guess this is a result of the fact that I've been eating a diet too high in cholesterol for too long.
  B)
  Several factors like my genetics and gender may have contributed to this, but I'm glad that medications can cure it.
  C)
  This explains why my skin was yellow-tinged lately and why I had those pains that spread to my upper back and right shoulder.
  D)
  I suppose the fever and vomiting I had this week was probably a sign of my gallstones too.

[underwood14]

Answer to Question 1

Ans:
D

Feedback:

Alcohol use, fever, hypotension, and tachycardia are often associated with pancreatitis, as are elevated serum amylase and lipase levels. These enzymes would unlikely rise in cases of hepatitis, cholecystitis, or cirrhosis. The precise mechanisms whereby alcohol exerts its action are largely unknown. The capacity for oxidative and nonoxidative metabolism of ethanol by the pancreas and the harmful by-products that result have been related to the disease process. Hepatitis C has an incubation period. Most adults who acquire the infection usually are asymptomatic. Jaundice is uncommon. Direct measurement of HCV in the serum remains the most accurate test for infection. Cirrhosis represents the end stage of chronic liver disease. The end result is liver failure that affects many organs. The patients usually have anemia, thrombocytopenia, endocrine disorders, skin lesions, azotemia and renal failure, and hepatic encephalopathy.

Answer to Question 2

Ans:
C

Feedback:

Gallstones can be caused by abnormalities in the composition of bile (increased cholesterol) and stasis of bile. The formation of cholesterol stones is associated with obesity and occurs more frequently in women. These factors cause the liver to excrete more cholesterol into the bile. Estrogen reduces the synthesis of bile acid in women. Cholesterol stones are extremely common in Native Americans. Jaundice and pain that radiates to the upper back and right shoulder are noted signs and symptoms of cholelithiasis. While cholesterol is a key element in the formation of gallstones, the particular amount ingested in the diet is not central to the development of the problem. Surgery, not medication, is the normal treatment modality, and fever and nausea are more closely associated with cholecystitis rather than cholelithiasis.

[LCritchfi]

Excellent

[epscape]

TYSM