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.

In the ER, Sarah is able to describe her symptoms to you. You make note of what Sarah had
eaten during the last 24 hours find that Sarah’s grandmother canned all of her own
vegetables. Her breathing then becomes labored. so you order a blood sample, to have her
gastrointestinal tract pumped, and prepare a mechanical respirator just in case. Thinking
she may have botulism, you ask that Sarah’s grandparents be contacted and samples of the
Thanksgiving meal retained, if possible, and sent to a local clinic for analysis.

Diagnosis: Botulism

Questions for understanding:

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?

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

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

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., just 3 days
after her due date. Delivery went quite smoothly, and that evening, mother and child rested
comfortably. Two days later, Kim and Michael were released from the hospital. That evening
at feeding time, Kim noticed that the whites of 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.

Upon examining Michael you inform Martin and Kim that the infant has neonatal 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 into the normal range.

Diagnosis: Jaundice

Questions for understanding:

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

2). What is the treatment for newborn jaundice?

3). Why did Michael’s skin turn yellow? What normally happens in healthy newborns without
jaundice?

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 and as a
result of the fear that what he was eating may be responsible for the pain. Otherwise,
Harold seemed fine.

You refer Harold to get an endoscopy. The endoscopy was performed at a hospital later that
week. The endoscope was equipped with a small claw-like structure that the doctor could
use in order to obtain a small tissue sample from the lining of Harold’s stomach, if required.
Diagnosis: Peptic Ulcer

Questions for understanding:

1). What is a peptic ulcer? What are most of them caused by? What is the most common
treatment for this disorder?

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

3). What is an endoscopy?

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 chocolate milk
shake. Pei spent much of that night n 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?

2). How is it treated? Does the person have to avoid milk products for the rest of their
lives?

3). Why is Pei’s ethnicity important with the diagnosis of lactose intolerance?
Extension Activity:

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.