Vincent Miller I HUMAN CASE STUDY QUESTIONS AND ANSWERS Exam TESTED AND CONFIRMED A+ ANSWER

Vincent Miller I HUMAN CASE STUDY QUESTIONS AND ANSWERS Exam TESTED AND CONFIRMED A+ ANSWER

Case History 15: Alcohol and the Digestive Tract
Chief Complaint: 62-year-old man with esophageal bleeding
History: Vincent Miller, a 62-year-old accountant, has had a "drinking problem" throughout
most of his adult life. He drinks about a half-case of beer each day. He has lost several jobs
over the years for drinking at the workplace or showing up for work drunk. He lost his
driver's license for drunk-driving, and his drinking has placed a considerable strain on his
marriage. He has tried several self-help programs as well as Alcoholics Anonymous, all with
little success. He has been hospitalized on several occasions over the years. Vincent has a
severe tremor in his hands (probably a result of excessive alcohol intake), which makes it
very difficult for him to use a spoon, fork, and knife to eat. It's your first day on the job as an
occupational therapist, and you are consulted by his physician to see if there is any way to
help Vincent use eating utensils. Not knowing anything about him, you open up his past
medical records, which, incidentally, are quite thick.
First Hospitalization:
You note that Vincent was hospitalized at age 32 with a complaint of vomiting up blood after
a drinking binge that lasted seven days and was marked by excessive and repeated
vomiting episodes. The vomitus was bright red.
The hospital chart lists a diagnosis of "Upper GI bleed" due to a Mallory-Weiss tear. You
look up "Mallory-Weiss tear" in an internal medicine textbook and see that it is defined as "a
longitudinal tear in the mucosa at the gastroesophageal junction -- i.e. in the area of the
lower esophageal sphincter -- caused by repeated vomiting."
Questions:
1. Why was the blood bright red, rather than the color of "coffee grounds"?
- NSAIDS is causing the stomach to bleed
2. Based upon your knowledge of the vomiting reflex, why might severe vomiting tear
the mucosa?

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