Emergency department for hematemesis

"Live" presentation of content and scholarly source due during scheduled virtual meeting Questions: Read the scenario below and identify the likely digestive system disorder the patient is experiencing. Explain the underlying pathophysiology (aka. cellular/tissue changes) and relate it to abnormal examination and diagnostic findings. Explain additional diagnostic testing, medical treatment, and nursing care to treat the patient and/or prevent future complications. Scenario: A 52-year old female is in the emergency department for hematemesis. She reports vomiting a large amount of dark red blood and almost “passed out”. Her partner called 911 after finding her kneeling over the toilet and groaning. She was cooperative, but lethargic and weak. She had to be lifted by paramedics onto the gurney for transport. She reports weakness, fatigue, abdominal distention and “heaviness”, dyspnea, shortness of breath (SOB) with exertion, and an unintentional 15 lb. weight gain. Past medical & family history She was diagnosed with depression and alcohol dependence 5 years ago. She was prescribed paroxetine for depression and takes it as prescribed. She attended alcohol rehabilitation and remained sober for about 2 years, but began drinking alcohol again to cope with the stress during the COVID-19 pandemic. She has smoked half a pack of cigarettes daily since her early 20s. She has a history of hepatitis C infection 8 years ago. She has a history of breast cancer in situ and was treated with a right lumpectomy 6 years ago. Her father died at the age of 58 from alcoholic liver disease; and he had a history of type 2 diabetes, hypertension, hyperlipidemia, and osteoarthritis. Her mother died at the age of 64 from a stroke; and she had a history of breast cancer and lupus. Her sister is alive at age 48 with a history of lupus and endometriosis. Vital signs Heart rate = 132 beats/min, regular Respirations = 28 breaths/min, slightly labored Oxygen saturation = 90% on 2L of oxygen via nasal canula Temperature = 99.8° Fahrenheit (oral) Blood pressure = 92/54 mmHg Pain = 5/10 (epigastric) Physical examination Neurologic – lethargic, easily aroused, oriented, cooperative, sclera jaundiced Skin – cool, dry, pale, intact, conjunctiva jaundiced, skin color appropriate for ethnicity Abdomen – bowel sounds hypoactive. Abdomen slightly firm and distended. Abdomen tender in right upper quadrant. Enlarged liver palpable. Small amount of dark, yellow, clear urine. Cardiovascular – heart rate rapid and regular. S1 and S2 heard. Peripheral pulses thready and 1+, pedal edema 1+, bilateral jugular venous distention present. No abnormal heart sounds. Pulmonary - lung sounds clear in apices, but bases diminished with crackles; SOB with exertion Musculoskeletal – full range of motion, strength 3/5 in extremities Diagnostic test results Chest x-ray – lungs with moderate pulmonary edema 12-lead electrocardiogram (ECG) – sinus tachycardia, no acute ischemic changes Esophagogastroduodenoscopy (EGD; aka. upper endoscopy) – esophagus with 2 medium-sized varices at the proximal and mid esophagus with bleeding. No other abnormalities. Computerized tomography (CT) scan of chest and abdomen – Enlarged liver with fibrosis, nodularity, and irregular contour. Esophageal thickening. No free air or other abnormalities. Serum results - abnormal results and normal ranges below, all other results within their normal range Blood urea nitrogen = 41...................................(6-20 mg/dL) Creatinine = 2.8...................................................(0.9-1.3 mg/dL) Total protein = 4.0...............................................(6.0-8.3 gm/dL) Albumin = 2.7.......................................................(3.5-5.0 gm/dL) Bilirubin (total) = 2.4...........................................(0.2-1.3 mg/dL) Aspartate aminotransferase (AST) = 73..........(10-59 U/L) Alanine aminotransferase (ALT) = 50..............(10-40 U/L) Ammonia = 92.....................................................(10-80 mcg/dL) Red blood cells (RBC) = 3.9...............................(4.2-5.4 x 1,000,000 cells/μL) Hemoglobin (HGB) = 8.2...................................(14.0-17.0 gm/dL) Hematocrit (HCT) = 26.7...................................(41-51%) Platelets (PLT) = 112.4.......................................(150-400 x 1000 cells/μL) You must start a thread before you can read and reply to other threads Criteria Unacceptable Below Average Average Above Average Excellent Criterion Score Original Post 0 points Did not post; or minimal, uninformative answer 1 point Brief or somewhat uninformative answer. Content somewhat incomplete, inappropriate, and/or incomprehensible 1.4 points Communicated a good understanding of the topic with content that is mostly comprehensive, accurate, and meaningful