Chapter+8+-+Joints+and+the+Skeletal+System

Chapter 8 - Exam Due Date = Wednesday, December 2nd

Case Studies Due = Tuesday, December 1st

Female: Gastrointestinal Case Histories - Case 2 A 26-year-old business executive complained of a dull pain (heartburn) behind the sternum. The pain was postprandial (occurred after meals) and disappeared within a few minutes to an hour. It was often associated with belching and often was worse on lying down or on exertion after heavy meals. Sometimes it radiated to the back, jaws, shoulders, and down the inner aspects of the arms, simulating angina pectoris. X-rays revealed a small portion of the stomach above the diaphragm, and an endoscopic biopsy revealed mucosal inflammation. Esophageal manometry (determining pressures at the lower esophageal sphincter, LES) revealed decreased LES pressure. Esophageal pH monitoring showed reflux of gastric contents into the esophagus and provided direct evidence of gastroesophageal reflux. Recommended treatment for this individual is avoidance of strong stimulants of gastric acid secretion (e.g., coffee, alcohol) and avoidance of certain drugs (e.g., anticholinergics), and specific foods (fats, chocolates, whole milk, and orange juice), and smoking, all of which reduce LES competence. Elevation of the head of the bed by about six inches is also recommended. Suggested treatments also include the use of cholinergic agonists (e.g., bethanechol) and the use of histamine (H2) antagonists (cimetidine).

Male: Cardiovascular Case Histories - Case 12 A 5'6", 210 lb., 64-year-old male business executive had a physical exam prior to his retirement from corporate work. His blood pressure was >180/115 on three separate days. Further examination showed normal to low plasma renin activity, elevated total peripheral resistance (TPR), cardiac output (CO) of 7.2 L/min, x-ray evidence of left ventricular hypertrophy, retinal hemorrhages, and mild polyuria. Recommended therapy was weight reduction to his ideal level, a low-salt diet (<2 gm/day sodium), prudent exercise, and a reduction in alcohol consumption (<3 oz whiskey/day). This change in lifestyle did little to change the condition. Medication was initiated in the form of an oral diuretic and progressed to a beta-blocker; eventually a vasodilator was included to reduce the blood pressure to <140/90.