NUR 606 Gastrointestinal Case Study

NUR 606 Gastrointestinal Case Study

NUR 606 Gastrointestinal Case Study

Introduction

The purpose of this presentation is to describe a patient case scenario and explore the possible conditions for this patient based on the symptoms and lab finings. We will also discuss the treatment modalities with their rationales based on the identified diagnosis.

Patient Presentation

The patient in the case study presents to the ER with a severely low hemoglobin and hematocrit count.

Clinical symptoms include listlessness, pale, pallor, and hypotensive.

The initial clinical impression is a blood loss via the gastrointestinal tract.

Possible Conditions

The likely diagnoses based on the patient’s symptoms and lab results are:
Acute Gastrointestinal Bleeding

Iron Deficiency anemia

Chronic Anemia secondary to GI bleeding

Acute GI Bleed

Gastrointestinal bleedings is divided into upper GIB (UGIB) and lower GIB (LGIB) depending on the location.  The typical signs of GIB are hematemesis, melena and hematochezia (Gaiani et al., 2018). GIB is defined as acute if it has a recent duration (less than 3 days). It can cause unstable vital signs, anemia, and the need for blood transfusion (Gaiani et al., 2018).

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The patient has positive findings of anemia like pale, pallor, and hypotension and low hemoglobin and hematocrit count, which could have been caused by acute GI bleeding.

Iron Deficiency Anemia (IDA)

The pathology of Iron deficiency anemia (IDA) includes inadequate dietary iron, bleeding, impaired iron absorption,

NUR 606 Gastrointestinal Case Study
NUR 606 Gastrointestinal Case Study

or loss of body iron. Clinical symptoms include pallor, fatigue, leg cramps when climbing stairs, cold intolerance, pica, reduced resistance to infection, and dysphagia. Diagnostic findings include low Hemoglobin, Hematocrit, mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC) (Kumar et al., 2022). The patient has features consistent with IDA like listlessness, pale, pallor, and hypotension and low hemoglobin and hematocrit count.

Chronic Anemia Secondary to GI bleeding

Mild, chronic GI bleeding mostly does not show any active bleeding but can lead to chronic anemia.  Anemia caused by occult gastrointestinal blood loss usually remains unnoticed until patient become symptomatic. In severe cases of chronic GI bleeding, patients present with symptoms and signs of anemia, like generalized weakness, pallor, dizziness, and shortness of breath or angina (Cotter et al., 2020). It is possible that the patient has had chronic GI bleeding leading to symptomatic anemia as evidenced by listlessness, pale, pallor, and hypotension and low hemoglobin and hematocrit count.

References

Cotter, J., Baldaia, C., Ferreira, M., Macedo, G., & Pedroto, I. (2020). Diagnosis and treatment of iron-deficiency anemia in gastrointestinal bleeding: A systematic review. World journal of gastroenterology26(45), 7242–7257. https://doi.org/10.3748/wjg.v26.i45.7242

Gaiani, F., De’Angelis, N., Kayali, S., Manfredi, M., Di Mario, F., Leandro, G., Ghiselli, A., Fornaroli, F., & De’Angelis, G. L. (2018). Clinical approach to the patient with acute gastrointestinal bleeding. Acta bio-medica : Atenei Parmensis89(8-S), 12–19. https://doi.org/10.23750/abm.v89i8-S.7861

Kumar, A., Sharma, E., Marley, A., Samaan, M. A., & Brookes, M. J. (2022). Iron deficiency anaemia: pathophysiology, assessment, practical management. BMJ open gastroenterology9(1), e000759. https://doi.org/10.1136/bmjgast-2021-000759