Medical Physiology: Integration Using Clinical Cases
695
Case 19–3: A Man with Abdominal Pain, Fever,
and Circulatory Failure
I. Case Presentation
a. A young man has increasing abdominal pain over three
days.
II. Physical Examination
a. He has a fever, increased heart and respiratory rates, and
low blood pressure.
b. He has pain and rigidity localized to the lower-right
quadrant of his abdomen.
c. His urine output is low.
III. Laboratory Tests
a. He has increased white blood cells suggesting an infection.
b. He has a metabolic (lactic) acidosis with a respiratory
compensation (low arterial
P
CO
2
)
.
c. He has an elevated creatinine, which indicates a decrease in
glomerular fi ltration rate.
IV. Diagnosis
a. A computed tomography (CT) scan shows an infl
amed
appendix, suggesting a diagnosis of appendicitis. The low
blood pressure suggests septic shock due to peritonitis
(ruptured appendix).
b. The diagnosis is confi rmed in an abdominal exploration
during which a perforated appendix is removed. The
membranes near it are infected, proving peritonitis.
V. Physiological Integration
a. Toxins from the bacteria have caused the low blood pressure
because of vasodilation.
b. The lower glomerular fi ltration rate is due to low blood
pressure and decrease renal perfusion.
VI. Therapy
a. Therapy consists of intravenous fl uids before and after
surgery to support cardiac output and blood pressure and
vasoconstrictor drugs to maintain blood pressure.
b. Antibiotic therapy is given to fi ght the peritoneal infection.
CLINICAL TERMS
appendicitis
692
atelectasis
688
bruit
685
catheter
691
computed tomography
(CT)
691
deep vein thrombosis
689
diplopia
684
embolism
689
Escherichia coli
692
exopthalmos
684
fever
693
goiter
686
Graves’ disease
686
hypercoagulability
690
hyperthyroidism
686
ischemia
693
low-resistance shock
693
methimazole
688
myocardial infarction
688
necrosis
691
palpitation
684
perforation
691
peritonitis
692
proptosis
684
propylthiouracil
688
pulmonary edema
693
pulmonary embolism
689
pus
692
radioactive iodide
688
recombinant tissue plasminogen
activator (rec-tPA)
690
sepsis
693
septic shock
692
systemic infl
ammatory
response
692
tachycardia
685
tachypnea
685
thrombus
689
thyroid-stimulating
immunoglobulin
(TSI)
686
thyrotoxicosis
686
ventilation-perfusion scan
689
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