Hepatitis B and C
What questions would you like to ask this patient about his symptoms?
Since it is important to examine the history of exposures, it would be important to know from the patient when the symptoms started. It would be critical to note the time he started experiencing fatigue and for how long. This would be the same for all the other symptoms including anorexia fever, abdominal discomfort, and myalgias.
What questions would you like to ask this patient about his life-style or past medical history?
This would involve a systematic enquiry about the patient's appetite, change in weight. Use of alcohol would also be an issue.
What are the pertinent positives and negatives on examination?
There are important facts for the diagnosis the patient responds to in the negative. The patient has no mouth lesions, no thyromegaly, no adenopathy, no rashes, no hemorrhoids felt, no edema and no swellings as well as non-palpable spleen. The positive is tenderness over the right upper quadrant without rebound.
Question4. What is the differential diagnosis based on the history and physical examination?
Emergency cardiopulmonary conditions such as severe pneumonia and heart attack will be ruled out if the right upper quadrant pain is not related to a traumatic event. Inflammation of the gallbladder is a common cause of right upper quadrant pain and will also be considered. Another serious condition to consider would be hepatitis though it is less common in occurrence than gallbladder inflammation in causing acute pain. Other differential diagnoses include gallstones, and abscess of liver, stomach ulcer, and liver enlargement as well.
Question5. What laboratory assessment would you do now?
Laboratory examination will consist of listening to the right upper quadrant with a stethoscope, touching, or palpating, for masses or unusual firmness, and determining the presence of other symptoms such as fever, nausea, vomiting or bowel changes. It is possible that some conditions may cause pain in the right upper quadrant of the abdomen, but the condition is related to structures in other parts of the body, such as the chest.
Question6. What do these laboratory results mean?
The mild increase in lymphocytes indicates a viral infection, autoimmune disorder or cancer of the blood or lymphatic system. Though high lymphocyte count can mean the patient's body is thwarting off an infection, illnesses such as tuberculosis, hepatitis may also cause the high count as well. This may also denote blood cancer; leukemia. The increasing alkaline phosphatase level is likely to be caused by liver diseases. The common cause is hepatitis although other liver enzymes may also elevate the phosphate level.
Question7. What should you do for the patient now?
The high levels of lymphocytes and phosphate is associated with drugs the patient is using thus, the patient is required to reduced medication, or stop it completely. For the elevated liver enzymes, anemia, obesity and alcohol, are the causes requiring the patient to adjust eating habits. Besides, the patient being alcoholic is required to cease his alcohol consumption.
Question8. What tests would you do now?
Additional tests are required to check for albumin and bilirubin. Other tests look at ALT, AST, and ALP. The other test would be liver biopsy test, to confirm the presence of hepatitis A or B. And liver damage from ingestion of toxins.
Question9.What does this mean and what should you tell the patient?
In most liver disease cases, ALT levels rise above AST levels. When AST levels are greater, it commonly indicates alcoholic liver disease. Elevated ALT and AST enzymes can also be the result of extreme exercise, which causes muscle damage. High AST and ALT levels indicate such conditions as viral hepatitis A or B. And liver damage from ingestion of toxins, including an overdose of acetaminophen. The most common cause of mild to moderate elevations in ALT and AST is a fatty liver, which is normally attributed to alcohol abuse but can also result from diabetic conditions and obesity.
Type 2 Diabetes Mellitus
Question1.What questions would you like to ask her about her symptoms?
It would be important to know from the patient when the symptoms started. It would be critical to note the time she started experiencing fatigue and for how long. This would be the same for all the other symptoms including weaknesses in her right foot as well as itching in her groin area.
Question2.What other personal and family-related questions would you like to ask her about her diabetes?
This would involve a systematic enquiry about the patient's appetite, change in weight. In addition, family members diagnosed with diabetes and exercise programs will be issues in this phase.
Question3.What would you like to ask about her medical history?
The patient's use of alcohol will be examined and whether she has had a breathing problem in the past. Besides, prior abdominal pains will for part of this examination.
Question4.What are the pertinent positives and negatives on the physical examination?
The negatives identified include; no petechiae or ecchymoses, neck without bruits or thyromegaly, clear nares and tympanic membranes. The positives which help for the diagnosis are moderately obese abdomen with bowel sounds heard in all four quadrants. Additionally, the other positive is diminished sensory perception to light touch on the soles of both feet along the metatarsal bar.
Question5.What laboratory tests would you order now?
The first step would involve check for changes in her bowel elimination pattern and stool's characteristics such as color, shape, consistency and smell. Besides, examination will consist of checking vital signs such as blood pressure, pulse rate, respirations, and temperature. The presence of low-pitched bowel sounds were also checked for in all four quadrants as well as palpation conducted for any tenderness in the left upper and lower quadrants.
Question6. How would you interpret these laboratory findings?
Peripheral neuropathy of the right foot indicates the patient's foot is malfunctioning, causing numbness, weakness, or pain and tingling. The patient's legs thus feel heavy leading to difficulty in walking. Besides, the neuropathy may result in visual impairment and as well affect bladder control and bowel movements. Additionally, the left ventricular hypertrophy is a sign the patient has an onset of high blood pressure, requiring the left ventricle to work harder. As the workload increases, the walls of the chamber grow thicker, lose elasticity and eventually may fail to pump with as much force as a healthy heart leading to heart failure.
Question7. What would you recommend at this time?
For the patient' condition, controlling her diabetes can improve the imminent neuropathy and hypertrophy. Physical therapy is recommended to increase muscle control and strength. She may use a cane, walker or braces on her legs to increase stability. Pain medications to control nerve pain are also prescribed. Besides medication, lifestyle changes, such as regular exercise, low-fat diet and smoking cessation is recommended.
Peptic Ulcer Disease
Question1. What is your differential diagnosis based on this limited history?
The patient is likely to be suffering from discomfort, heartburn and nausea. The may have a recurrent pain in the upper abdomen Discomfort, in this context, includes mild pain, upper abdominal fullness and feeling full earlier than expected with eating. The differential diagnosis of this patient's is caused by gastritis, stomach ulcer, pancreatic diseases, pregnancy as well as diabetes mellitus (Kato, Nomura, Stemmermann, & Chyou, 1992).
Question2.What questions would you like to ask this patient about his symptoms?
In the examination of the patient, it is vital to note the time he started having abdominal discomfort, heartburn as well as nausea and for how long. This would be the same for all the other symptoms such as kidney pains as well as watery diarrhea.
Question3. What questions would you like to ask about his recent and past medical history?
Since the patient denies having most symptoms of peptic ulcer disease, he is asked if he has a previous history of heartburn, the use certain forms of medications (Chung, et al., 2001). In addition, recent weight changes, appetite fluctuation as well as exercise program will be examined.
Question4. What are the pertinent positives and negatives on the physical examination?
The pertinent positives from the physical examination are present bowel sounds, and epigastric tenderness as well as non-distended abdomen. The negatives include no thryomegaly, no bruits, no adenopathy, no hemorrhoids, no edema, and no pulse bruits.
Question5. What initial diagnostic tests would you obtain now?
Initial diagnosis involves examinations of skin color; pale skin indicates chronic gastritis, peptic ulcer or stomach cancer. Abdominal examination for tenderness is the epigastric area initiated to detect ulcer.
Question6. What test should be chosen to best evaluate for peptic ulcer disease in this patient?
The breath test will be used to detect H. pylori. The patient will be requested to drink a tasteless liquid with radioactive carbon atoms. Approximately in an hour's time, he will blow into a sealed bag and when infected, the bag will have the radioactive carbon. This test is vital as it helps in monitoring the patient's response to treatment. In addition, biopsy is also used…