Case study 2
21 y/o female college student, was seen in the student health center for increasing episodes of abdominal fullness and discomfort with alternating diarrhea and constipation. Reports being diagnosed with irritable bowel syndrome several years ago, was told to eat more fiber, but nothing has seemed to be effective in reducing her abdominal distress, is taking a heavy course load this semester, has to work 20 hours each week for her work-study contract, and eats mainly fast foods and drinks several coals daily.
CASE STUDY 3
Mr. Begay is a 55-year old Native American man admitted with a diagnosis of cirrhosis of the
liver. He has been vomiting for 2 days and noticed blood in the toilet when he vomits. He has
had cirrhosis for 12 years, acknowledges that he had been drinking heavily for 20 years but has
been sober for the past 2 years. He complains of anorexia, nausea, and abdominal discomfort.
On his physical examination, the findings were thin and malnourished, has moderate ascites,
jaundice of sclera and skin, 4+ pitting edema of the lower extremities, liver and spleen are
palpable. The laboratory values are as follows: total bilirubin: 15mg/dl, serum ammonia 220
mcg/dl, AST 190 U/L, ALT 210 U/L.
CASE STUDY 4
75 y/o African-American male, was admitted to the hospital emergency department with partial-
thickness burns that involved his face, neck, and upper trunk, lacerated right leg, injuries
occurred about 24 hours earlier when he fell out of a tree onto his burning gas grill while trying
to get his cat. Complains of slightly hoarse voice and irritated throat, states that he tried to treat
himself because he does not have health insurance, has been coughing up sooty sputum, and
complains of severe pain in left hip.
Leg wound is gaping and looks infected, temperature 101.1 F, x-rays reveal a fractured right tibia
and fractured left hip, WBCs 26,400/μl with 80% neutrophils (10% bands), and surgery is
performed to repair the left hip.