Medical Science for Pathogenesis and Diagnosis- myassignmenthelp

Question: Discuss about theMedical Science for Pathogenesis and Diagnosis. Answer: History In the given case study, 52-year-old Emma Smith had a gradual onset of abdominal pain and had been vomiting intermittently and unable to tolerate oral fluids. She is unable to localize the pain and it started in the right lower quadrant in on and off form. The abdomen is rigid, tender on palpation and appeared flushed, diaphoretic. On questioning, her pain scored 9/10 on pain scale, however, there was no pain during her last urination. She was slightly agitated, vomiting and skin appeared warm to touch. Her vital signs included pulse 120 and thready, low blood pressure 90/60, sinus tachycardia with constant pain in the stomach. The above condition may be a case of appendicitis as the pain began in the right lower quadrant of the stomach (Shogilev et al., 2014). Provisional diagnosis Acute appendicitis may be an emergency condition that requires immediate care and management of the condition. The provisional diagnosis is the temporary diagnosis that can be done with the best information available in that situation which further requires confirmation. The emergency care service would help to provide the care during Emmas transfer from home to hospital. The immediate life saving care provided by the first responder would give oxygen administration, automated external defibrillator providing care minimum emergency service, and stabilize her condition before ambulance arrive and assist her to the hospital . In differential diagnosis, appendicitis can be tricky for diagnosis until the typical symptoms are looked for. The main consideration on a priority basis is pain management and checking of vital signs like stomach pain, ultrasound or CT scan) oxygen saturation levels, blood pressure, pulse rate and temperature (Ehrman Favot, 2017). Aetiology The main cause of appendicitis is due to appendiceal lumen that results in obstruction mainly by lymphoid hyperplasia caused by some foreign body or worms. There is inflammation of appendix and this leads to multiplication of bacteria inside the organ and pus formation. The obstruction may lead to bacterial overgrowth, distension, ischemia and abdominal inflammation. There is blocking of appendix by stool or foreign body that causes acute or chronic pain. Concisely, there are two main causes of appendicitis: stomach infection that might have moved to appendix or a hard stool piece may be trapped in appendix and bacteria present in it may have infected the appendix (Bowen, 2015). Epidemiology Appendicitis is one of the most common acute abdominal emergency cases; however, the incidence is low in the population with 6.7% females and 8.6% males. The lifetime risk is 12% among males and 23% among females. This condition occurs in people aged early teens and late 40s. This shows male to female predominance and is a global disease. The prevalence is stabilized in most Western countries and suggests that the incidence is rising rapidly. Among these, Europe has the highest incidence and incidence in Australia is comparable to Western Europe. The annual mortality rate in Australia due to appendicitis has decreased by 42.7%, however, the incidence is escalating that is becoming a major global health issue and burden of disease (Bhangu et al., 2015). Pathophysiology As the signs and symptoms of Emmas health conditions, indicates to the possibility of appendicitis, the pathophysiology of appendix is going to be discussed. Due to the hindrance in the lumen, it becomes a closed loop and becomes completely filled with mucus.This condition leads to intramural and intraluminal pressure and distension. Progression of such condition leads the multiplication of resident bacteria in the appendix. Some of the resident bacteria of appendix are Bacteroids fragilis and Escherichia coli(Flum, 2015).The reason of Emmas vomiting and intolerable pain is the distension of the lumen of the appendix. This condition causes reflex anorexia, vomiting, mild fever, nausea and severe abdominal pain. The pressure of the lumen of appendix keeps on increasing and exceeds the venous pressure leading to the thrombosis of small venules and different capillaries. However, in this condition as well the arterioles remains open and this makes the appendix congested and engorged. Fu rthermore, inflammation in this region leads to serosa of the appendix and leads to parietal peritoneum, leading to the right lower quadrant pain in the abdomen region. Finally, the resident bacteria start forming pus that leak out of the dying walls makes the disease more complicated (Wolfe Hanneman, 2013). Assessment There are several tool to assess appendicitis in patients. As the patient is, complaining about the stable sever pain in her lower right abdomen and her abdomen is rigid, swollen and tender. Hence, ultrasonography will be used to diagnose the cause of paining. Ultrasonography is an easy and effective way for primary diagnosis of the pain and if the process provides negative result, CT scan can be used to diagnose further. Appendixdoes notappear generally in the ultrasonography procedure. However, after the appendix becomes swollen and start paining, the ultrasonography test provides a clear picture of 7 to 9 mm of swollen structure in the lower right quadrant of abdomen. Hence, it is an effective tool to diagnose appendix, if the patient is suffering from the disease (Kim et al., 2012). To detect the possibility of appendicitis, urinary 5-HIAA tests can be performed. The proportion of HIAA in bloodincreases with the onset of the disease and during the necrosis of the appendix becomes low in amount. Hence, from the urinary 5-HIAA test, the level of HIAA in Emmas body can be detected and a clearer picture of disease can be achieved(Kim et al., 2012). Treatment Early treatment of Emma should include drugs to manage her pain and to lower the health consequences due the symptoms. In the possibility of appendix, the patient should be administered to crystalloid therapy. Emma is showing the signs of dehydration and she is unable to take any fluid inside her body hence crystalloid therapy will be effective to deal with her signs of dehydration and septicemia (Lacher et al., 2012). Sheshould be provided with analgesics (parenteral and antiemetic) to comfort her abdominal pain. This will help to calm her condition and her blood pressure will improve (Lacher et al., 2012). Transport Transport of the patient to the hospital was little difficult as she was suffering from severe pain. A team of quick action team accompanied the ward boys in the ambulance to transfer the patient from home to hospital and they carry out their provisional care techniques to calm the patient in the ambulance. References Bhangu, A., Sreide, K., Di Saverio, S., Assarsson, J. H., Drake, F. T. (2015). Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management.The Lancet,386(10000), 1278-1287. Bowen, W. H. (2015).Appendicitis. Cambridge University Press. Ehrman, R. R., Favot, M. J. (2017). Can Abdominal Ultrasonography Be Used to Accurately Diagnose Acute Appendicitis?.Annals of Emergency Medicine,70(4), 583-584. Flum, D. R. (2015). Acute appendicitisappendectomy or the antibiotics first strategy.New England Journal of Medicine,372(20), 1937-1943. Kim, K., Kim, Y. H., Kim, S. Y., Kim, S., Lee, Y. J., Kim, K. P., ... Song, K. J. (2012). Low-dose abdominal CT for evaluating suspected appendicitis.New England Journal of Medicine,366(17), 1596-1605. Lacher, M., Muensterer, O. J., Yannam, G. R., Aprahamian, C. J., Perger, L., Megison, M., ... Harmon, C. M. (2012). Feasibility of single-incision pediatric endosurgery for treatment of appendicitis in 415 children.Journal of Laparoendoscopic Advanced Surgical Techniques,22(6), 604-608. Shogilev, D. J., Duus, N., Odom, S. R., Shapiro, N. I. (2014). Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014.Western Journal of Emergency Medicine,15(7), 859. Wolfe, J. M., Henneman, P. L. (2013). Acute appendicitis.women,1, 2.