Digestive System Case Studies

You are an ER doctor that is working the night shift and are presented with several
patients over the course of your shift. Your job is report out at the end of the shift
with your findings, including information about each of the patients you have seen.
With every case study, there are questions that need answering in order for you to
educate the next shift.

1). Sarah, a twenty-one year old student at Iowa State University had spent
Thanksgiving day with relatives at her grandparent’s farm. During her drive back to
campus on Friday morning her vision became blurry, and she was forced to pull over
to the side of the road. As she sat in her car, her vision worsened. She opened the car
hood in hope of attracting aid and tried to relax. In a short time, a highway patrol
officer pulled over and approached Sarah. By this time, Sarah was having trouble
swallowing and speaking clearly. The officer helped Sarah to his car and rushed her to
the emergency room at a nearby hospital.

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In the ER, Sarah is able to describe her symptoms to you. You make note of what

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Sarah had eaten during the last 24 hours find that Sarah’s grandmother canned all of

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her own vegetables. Her breathing then becomes labored. so you order a blood

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sample, to have her gastrointestinal tract pumped, and prepare a mechanical

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respirator just in case. Thinking she may have botulism, you ask that Sarah’s
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grandparents be contacted and samples of the Thanksgiving meal retained, if
possible, and sent to a local clinic for analysis.
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Diagnosis: Botulism
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Questions for understanding:

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1). What causes botulism? What caused the botulism in Sarah’s case? What
symptoms did she have that prompted you to think it was botulism?
Botulism occurs when food contaminated with the toxin is eaten. It most
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commonly produced by a bacterium called Clostridium botulinum. In Sarah’s case, It

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said that Sarah had eaten during the last 24 hours is her grandmother’s home-
canned vegetables. The bacteria is found in soil and can survive, grow and produce a
toxin in a certain conditions such as when food is improperly canned. Her
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grandmother didn’t properly canned her own vegetables and that’s why the bacterial
spores grow in her intestinal tract and causes botulism. The symptoms she have that
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prompted me to think it was botulism is when she had a blurry vision while she was
driving and when the patrol officer approached her, she was having trouble
swallowing and speaking clearly. And by the time she was in the hospital, her
breathing becomes labored. It means that toxin spreads and causes muscle
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weakness.

2). What is your treatment for Sarah? What is the mortality rate? What is the
primary case of death in botulism cases?

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 The treatment I’ll gave her is a drug called an antitoxin (botulinum antitoxin)
since the bacteria produces toxins and attacks the body so the antitoxin will prevent
it from causing more damage. It does not heal the damage has been caused but it
will fight the toxin. And we will take good care of her and assist her if she’s having
trouble in breathing or sort of problems she may experience. Overall Mortality rate of
5-10% but botulism is rare so that’s why mortality rate is low. The primary case of
death in botulism is suffocation since the toxin affects the muscle control throughout
your body can cause many complication.

3). What two organ systems are primarily affected by botulism?

The nervous system and muscular system associated with digestive system
since the toxin was easily absorbed and cause infection in intestinal tract. A
neurotoxin actually paralyzes the nerves so that the muscles cannot contract

2). Martin and Kim were both twenty-five when they had Michael, their first child.
Kim remained very healthy during her pregnancy and went into labor at 9:00 p.m.,

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just 3 days after her due date. Delivery went quite smoothly, and that evening,

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mother and child rested comfortably. Two days later, Kim and Michael were released

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from the hospital. That evening at feeding time, Kim noticed that the whites of

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Michael’s eyes seemed just slightly yellow, a condition that worsened noticeably by
the next morning. Kim decided to bring the newborn into the ER the next evening.

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Upon examining Michael you inform Martin and Kim that the infant has neonatal
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jaundice, a condition quite common in newborns and one that need not cause them
too much concern. You ask that the parents to follow up with Michael’s pediatrician in
order to monitor blood bilirubin concentration until the bilirubin concentration drops
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into the normal range.

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Diagnosis: Jaundice

Questions for understanding:

1). What is jaundice? What is it caused by? Which of Michael’s organs is responsible
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for this condition?

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Jaundice is a condition in which the skin, white of eyes and mucous membrane
turn yellow because of a higher level of bilirubin, a yellow pigment of red blood cells.
It caused by obstruction of the bile duct, by a liver disease or by excessive
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breakdown of red blood cells. In Michael’s case, the organ that is responsible to his
condition is his liver. The baby’s liver isn’t mature enough to get rid of bilirubin in the
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bloodstream.

2). What is the treatment for newborn jaundice?

If the bilirubin is in high level, the treatment will be Phototherapy.
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Phototherapy is a treatment with a special type of light (not sunlight). It’s used to
treat newborn jaundice by lowering the bilirubin level in the baby’s blood. This
treatment use ultraviolet light to break down the bilirubin overload. If the the
newborn jaundice is mild, ensure that they are fed regularly by your breast milk.

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 3). Why did Michael’s skin turn yellow? What normally happens in healthy newborns
without jaundice?
Because of his bilirubin levels. Bilirubin is an orange-yellow pigment that
occurs normally when your red blood cells break down. He had too much bilirubin
that’s why his skin turn yellow since bilirubin is orange-yellow pigment. Signs that the
liver isn’t breaking down waste properly and cleaning the bilirubin from your blood
Those healthy newborns without jaundice have normal bilirubin levels and their liver
is breaking down waste properly.

3). Harold, a fifty-eight year old grocery store manager, had recently been waking up
in the middle of the night with abdominal pain. This was happening several nights a
week. He was also experiencing occasional discomfort in the middle of the afternoon.
The pain finally becomes so severe that he comes into the ER.

You listen as Harold describes his symptoms and then ask Harold some questions. You
note that Harold’s appetite has suffered as a result of the pain he was experiencing

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and as a result of the fear that what he was eating may be responsible for the pain.

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Otherwise, Harold seemed fine.

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You refer Harold to get an endoscopy. The endoscopy was performed at a hospital

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later that week. The endoscope was equipped with a small claw-like structure that

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the doctor could use in order to obtain a small tissue sample from the lining of
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Harold’s stomach, if required.
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Diagnosis: Peptic Ulcer

Questions for understanding:
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1). What is a peptic ulcer? What are most of them caused by? What is the most
common treatment for this disorder?
Peptic ulcers are sores that develop in the lining of the stomach, lower
esophagus or small intestine. Most peptic ulcers are caused by the bacterium
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Helicobacter pylori. The most common treatment of this disorder are antibiotic drugs
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to kill H. pylori bacteria and medications like PPIs (Proton Pump Inhibitors) to get rid
of acid in your stomach.

2). What is the body’s natural protection against peptic ulcers?

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A human glycoprotein called alpha 1,4-linked N-acetylgucosamine. It is

confined to the stomach's deeper mucosa lining.
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3). What is an endoscopy?

Endoscopy is a medical procedure where a long, typical slender and tubular
instrument will be inserted in the mouth to observe an internal organ or tissue in
detail, specifically the interior of a hollow organ or cavity of the body
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4). Pei, a twenty-six year old Asian graduate student in computer science, had been
experiencing occasional discomfort after meals. The discomfort reached a new peak
last Thursday evening about an hour after eating a cheeseburger and a large

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 chocolate milk shake. Pei spent much of that night in pain. She had abdominal
cramps and diarrhea and also felt sick to her stomach so Pei went to ER.

You ask Pei a number of questions and note that Pei's discomfort seemed to be
associated with dining out (her favorite fast food meal is a double cheese burger and
a chocolate shake.) Pei tells you that on most evenings she cooks for herself, usually
preparing traditional Asian cuisine, and that she seldom experiences any discomfort
after eating at home. You ask if she uses very much milk or cheese when preparing
meals at home, and she tells you that she rarely uses milk products while cooking at
home.

Diagnosis: Lactose
Intolerance
Questions for understanding:

1). What is lactose intolerance? What is it caused by? How is it diagnosed?

Lactose intolerance is a digestive disorder caused by the inability to digest

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lactose, the main carbohydrate in dairy products. It caused by the lack of production

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of the an enzyme, lactase, which is needed to digest lactose. So if you have a lactase

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deficiency, it means your body does not produce enough lactase and the lactose in

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your food into the colon instead of being processed and absorbed. This cause the
symptoms of lactose intolerance. A doctor can usually tell by asking questions about

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your symptoms or he may also ask that you avoid dairy products for a short time to
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see if your symptoms improve.
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2). How is it treated? Does the person have to avoid milk products for the rest of
their lives?
There’s no cure for lactose intolerance but a lot of people can handle their
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symptoms by putting some changes in their diet. There also some cases of lactose
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intolerance caused by gastroenteritis but it is temporary and will improve within

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weeks if a strict proper diet is followed. There are also other cases that is permanent
so you just need to follow a proper diet.

3). Why is Pei’s ethnicity important with the diagnosis of lactose intolerance?
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Her ethnicity is important with the diagnosis of lactose intolerance because

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African-American and Asian ethnicities see a 75%-95% lactose intolerance rate and
also she’s an Asian.
Extension Activity:
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Choose a digestive system disease NOT listed above and create your own case study
using the symptoms a person may experience if they have the disease.
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Extension Activity:
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Maxine, a 3 months old infant is brought into the ER at the general hospital
you are working by her parents. You ask her parents what is the problem that the 3
months old experienced. They comment that they can’t get their little daughter to
eat anything, and when something does down, she has severe projectile vomiting, in
addition their little girl wants to eat soon after vomiting. You ask them a few more
questions about the symptoms including if they notice wave-like contractions

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 (peristalsis) that ripple across their baby’s upper abdomen soon after feeding but
before vomiting and if their daughter cries without tears or become lethargic. They
told you that they noticed both.
After hearing the parents’ explanation, the examination started. You checked
the baby’s abdomen to see if there is a lump, which is usually firm and movable and
feels like an olive. You felt the lump, it’s a strong indication that their baby has Pylori
Stenosis. You refer to the parents that their baby might have blood test to check
levels of electrolyte (minerals that help keep fluids balanced and vital organs working
properly. She might have electrolyte imbalance. It often happens due to ongoing
vomiting of stomach acid and dehydration, and needs to be corrected. And also an
abdominal ultrasound and asked them that the baby not be fed for several hours
before an ultrasound.

Diagnosis: Pyloric Stenosis

Cause

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It's thought that babies who develop pyloric stenosis are not born with it, but
have progressive thickening of the pylorus after birth. A baby will start to show

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symptoms when the pylorus is so thick that the stomach can't empty properly like
what happened to Maxine. The cause of this thickening isn't clear. It might be a

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combination of several things; for example, use of erythromycin (an antibiotic) in
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babies in the first 2 weeks of life or antibiotics given to moms at the end of
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pregnancy or during breastfeeding can be associated with pyloric stenosis.

Treatment
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You told that their baby will be admitted to the hospital and prepared for
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surgery. Any dehydration or electrolyte problems in the blood will be corrected with
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intravenous (IV) fluids, usually within 24 hours. You explained the surgical procedure
called pyloro,yotomy which involves cutting through the thickened muscles of the
pylorus, will relieve the blockage. The pylorus is examined through a very small
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incision, and the muscles that are overgrown and thickened are spread and relaxed.
After a successful pyloromyotomy, the baby won't need to follow any special feeding
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schedules and will probably examine the child at a follow-up appointment to make
sure the surgical site is healing properly and that the baby is feeding well and
maintaining or gaining weight. Pyloric stenosis should not happen again after a
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pyloromyotomy.
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