Case 3 - 10 minutes
Mr Larry Torr is a 62 year old male lawyer. He has a long history of excessive alcohol intake and a number of health problems arising from this. He presents at the Emergency Department after multiple episodes of vomiting copious amounts of blood. The blood loss is ongoing and he is becoming increasingly hypotensive.
Part A - 5 minutes
- A possible cause of Mr Torr’s problem is bleeding from a peptic ulcer. Discuss the factors (aggressive and protective) acting on the gastric/duodenal mucosa that can influence the development of ulcers and explain the rationale for current ulcer treatment with antibiotics.
Aggressive Acid, enzymes
Protective: Bicarb, mucosa
ulcer treatments with antibiotics are due to the bacteria h pylori which inflames the stomach lining and leads to destruction of the protective bicarb mucosa layer
Part B - 5 minutes
- Another possible cause of Mr Torr’s problem is a complication arising from portal hypertension.
Define and describe two (2) mechanisms relevant to Mr Torr’s presentation, whereby blood can return to the systemic circulation. Name both the arterial and venous vessels involved.
anastomases
- oseopahageal varices
- haemohorroidal varices
- Without further investigations, which of these two mechanisms could be used to confirm preliminary diagnosis of portal hypertension. Explain your reasoning.