Case Study

Case 1

A 46-year-old patient B. suffers from gastric ulcer. He has been admitted as an emergency into the surgery department with a preliminary diagnosis of gastric perforation. On admission: acute pain in the epigastrial region, rigid abdomen, tenderness, signs of peritoneal irritation; body temperature 38.5^oC; absence of bowel sounds; marked leukocytosis; increased erythrocyte sedimentation rate. Analysis of the aspirated fluid (400 ml of opalescent fluid was evacuated during the needle drainage of the abdomen) showed the presence of a great quantity of leukocytes, protein 4%, various types of bacteria including anaerobic. A plain radiograph of the abdomen demonstrated the presence of air under the diaphragm. The patient was transported into the surgery.

Questions:

Can you confirm or disprove the preliminary diagnosis of gastric perforation? Substantiate your conclusion.

Define the type of pathologic process in the patient on admission.

What are the causes and mechanisms of each of the symptoms presented by the patient?

Define the type of fluid evacuated from the patient's abdominal cavity. Describe the characteristic properties of this fluid and explain the mechanisms of its formation.

Case 2

Two industrial workers visited a primary care physician with heat burns of the shin area. They received them as a result of breakdown of a boiler. They presented with a similar set of complaints of headache, pain and swelling of skin in the injured area. On examination: patient A. had red, hyperemic shins with marked edema; patient B. had, in addition, blisters filled with a yellowish transparent fluid. Both patients received treatment recommendations, and were accorded a sick-leave. However, both of them ignored the doctor's advice. Three days later the patient A.'s condition improved, and the patient B.'s one worsened considerably. The latter developed extensive edema and pain in the injured areas, his body temperature increased up to 38.9⁰C; the site of the heat burn was covered with numerous blisters filled with pus. Bacteriologic analysis of the purulent contents revealed the presence of staphylococci.

Questions:

What pathologic process(es) developed in the given patients? What blood test can confirm the presence of this process in the victims of the industrial accident?

How can you explain the different course of development of the same pathologic process in the patients?

What mechanisms underlie the clinical symptoms in the patient B.?