The initial post must include responses to all the questions in both case studies.
Mr. X, age 57, presented to his physician with marked fatigue, nausea with occasional diarrhea, and a sore, swollen tongue. Lately he also has been experiencing a tingling feeling in his toes and a feeling of clumsiness. Microscopic examination of a blood sample indicated a reduced number of erythrocytes, many of which are megaloblasts, and a reduced number of leukocytes, including many large, hypersegmented cells. Hemoglobin and serum levels of vitamin B12 were below normal. Additional tests confirm pernicious anemia.
Discussion Questions
- Relate the pathophysiology of pernicious anemia to the manifestations listed above.
- Discuss how the gastric abnormalities contribute to vitamin B12 and iron deficiency and how vitamin B12 deficiency causes complications associated with pernicious anemia.
- Discuss other tests that could be performed to diagnose this type of anemia.
- Discuss the treatment available and the limitations.
Ms. L, a 19-year-old woman with no previous medical history, was involved in a serious automobile accident in which her best friend died. Examination by EMT personnel first on the scene revealed she had only minor scrapes and bruises and no sign of head trauma. While en route by ambulance to the hospital, Ms. L complained of thirst and appeared restless. Further examination indicated a rapid pulse and respirations, with her blood pressure now at 100/60 mm Hg. She appeared less responsive to the paramedics. She was slipping into circulatory shock as they checked her again for internal injuries.
Discussion Questions
- Discuss the contributing factors to shock in this case and the pathophysiologic changes causing the changes in vital signs.
- Discuss the signs and symptoms of shock, including the rationale for each, as seen in the early stage, and as compensation mechanisms respond.
- Discuss emergency and follow-up treatment for shock and for complications that may arise if not treated quickly.
- Compare the types of shock, giving a specific cause, classification, and any significant changes in onset or manifestations.
Expert Solution Preview
Introduction:
Pernicious anemia is a condition that occurs when a person’s body cannot absorb enough vitamin B12 from the gastrointestinal tract. Vitamin B12 is important for the production of red blood cells, and a deficiency can lead to anemia. Shock, on the other hand, is a life-threatening condition that happens when the body fails to get enough blood and oxygen to its vital organs. In this essay, we will address the pathophysiology, diagnosis, treatment, and complications of these two medical conditions.
1. Relate the pathophysiology of pernicious anemia to the manifestations listed above.
The pathophysiology of pernicious anemia is related to the inability of the body to absorb vitamin B12. Vitamin B12 is absorbed in the intestine, and for it to be absorbed, it has to combine with intrinsic factor, which is made in the stomach. In pernicious anemia, the patient’s body produces antibodies that attack intrinsic factor or the cells that make it. This inhibits the absorption of vitamin B12, which is essential for red blood cell production. The reduction in red blood cells results in anemia, causing the manifestations of fatigue, nausea, and diarrhea. The tingling sensation in toes is due to nerve damage caused by the deficiency of vitamin B12.
2. Discuss how the gastric abnormalities contribute to vitamin B12 and iron deficiency and how vitamin B12 deficiency causes complications associated with pernicious anemia.
Gastric abnormalities such as atrophic gastritis, gastric bypass surgery, and partial gastrectomy can cause a deficiency in vitamin B12 by inhibiting intrinsic factor production, thereby causing pernicious anemia. Iron absorption is also affected in these conditions, leading to iron deficiency anemia. Vitamin B12 is essential for nerve function and its deficiency can lead to neurological symptoms, such as numbness, tingling in the feet and hands, and cognitive impairment. If untreated, it can lead to severe neurological deficits.
3. Discuss other tests that could be performed to diagnose this type of anemia.
Other tests that can be performed to diagnose pernicious anemia include Schilling test, anti-parietal cell and anti-intrinsic factor antibody tests, and endoscopy to examine the stomach and intestine for abnormalities. The Schilling test is a diagnostic exam used to measure how much of an oral dose of vitamin B12 is absorbed by the body. Doctors may also perform a complete blood count, serum vitamin B12, and homocysteine levels to diagnose pernicious anemia.
4. Discuss the treatment available and the limitations.
Treatment for pernicious anemia involves lifelong vitamin B12 supplementation. This can be done through injections, nasal sprays, or oral supplements. The limitation is that oral supplements are not effective in patients with severe malabsorption of vitamin B12. It is also important to treat the underlying gastric abnormality if it is causing the condition. Patients may require blood transfusions if they have severe anemia.
1. Discuss the contributing factors to shock in this case and the pathophysiologic changes causing the changes in vital signs.
In this case, Ms. L may be experiencing hypovolemic shock due to blood loss from internal injuries sustained in the automobile accident. Other contributing factors to shock may include decreased cardiac output, which can occur due to damaged heart muscle or abnormal heart rhythm. The pathophysiologic changes in shock result from the body’s attempt to restore blood pressure and maintain organ perfusion. The sympathetic nervous system activates, causing vasoconstriction, leading to increased peripheral resistance and decreased venous return. This results in an increased heart rate, which is the body’s compensation mechanism to increase cardiac output.
2. Discuss the signs and symptoms of shock, including the rationale for each, as seen in the early stage and as compensation mechanisms respond.
Early signs of shock include thirst, rapid breathing, rapid pulse, and a decrease in urine output. These signs occur due to decreased blood volume, which triggers the hypothalamus to activate the thirst center, causing a sensation of thirst. The rapid breathing results from metabolic acidosis due to anaerobic metabolism. Rapid pulse occurs as a result of increased sympathetic output. As compensation mechanisms respond, respiratory rate may increase, blood pressure may decrease, and the heart may beat faster.
3. Discuss emergency and follow-up treatment for shock and for complications that may arise if not treated quickly.
Emergency treatment for shock involves increasing blood volume through intravenous fluids, blood transfusions, and pressor medications. This is done to stabilize the patient’s vital signs and prevent further damage to organs. Follow-up treatment may include identifying and treating the underlying cause of shock, such as stopping bleeding, administering antibiotics, or performing surgery. Complications from shock may include organ damage, infection, and sepsis. It is important to treat shock quickly to prevent these complications from developing.
4. Compare the types of shock, giving a specific cause, classification, and any significant changes in onset or manifestations.
There are different types of shock, including hypovolemic shock, cardiogenic shock, distributive shock, and obstructive shock. Hypovolemic shock occurs due to decreased blood volume, which can be caused by bleeding or dehydration. Cardiogenic shock results from a malfunction in the heart, leading to decreased cardiac output. Distributive shock, such as septic shock, occurs when the distribution of blood flow is altered, leading to decreased peripheral resistance. Obstructive shock occurs when there is a blockage in the circulatory system, such as pulmonary embolism or cardiac tamponade. The onset and manifestations of each type of shock may vary, depending on the underlying cause.
