Case Study

Case 1

A 68-year-old male patient D. presented with chronic hepatitis and liver cirrhosis. The doctor introduced a needle into the abdominal cavity to perform aspiration of ascitic fluid. By the fifteenth minute, after 5 L of fluid had been removed, the patient felt bad, complaining of weakness, dizziness, and nausea. But the procedure was continued. After 1.5 L more fluid had been evacuated the patient developed syncope and lost consciousness. Several minutes later, after the emergency treatment the patient regained total consciousness but still complained of weakness, dizziness, and nausea.

Questions:

What was the doctor's mistake during the performance of ascitic fluid aspiration?

What are the mechanisms of syncope after the removal of ascitic fluid?

What are the possible mechanisms of adaptation of the brain circulation in this case?

Why did the adaptive mechanisms turn out to be insufficient in this patient?

Case 2

Examination of the patient with mitral stenosis found out marked cyanosis and insignificant edema of extremities, brushes are cold. Biomicroscopic research of microcirculation of nail-bed vessels revealed dilation of venous micro vessels, delay of blood-flow.

What type of peripheral blood circulation disorder is this?

What is the pathogenesis of this disorder? What is the pathogenesis of described symptoms?

Case 3

A 56-year-old male patient presented with complaints on fatigability and pains in the gastrocnemius muscles when walking. The symptoms were relieved by rest. This is called the symptom of "intermittent claudication". In addition, he experienced a sensitivity to cold, numbness, pins-and-needles, tingling (paresthesia) in his legs at rest. The patient had a long history of heavy smoking since his teens. His occupation required working outdoors even in cold seasons when he sometimes suffered from cold. The patient's examination showed that skin on both soles was pale and felt cool and dry; the nails crumbled; no pulse was felt on posterior tibial arteries on both legs. The preliminary diagnosis was thrombangitis obliterans.

Questions:

What form of organ circulation disorders is observed in the presented patient? Name its characteristic features.

What are the possible causes and mechanisms of this form of the circulation disorders?

What is the possible outcome of the circulation disorder in this case?

What are the likely mechanisms of development of each symptoms seen in the patient?

Case 4

An ambulance came 10 min after the vehicle accident, and the doctor started the emergency aid to the accident victim with a blunt trauma of the chest and open fracture of the right leg. A tourniquet was applied to the injured leg to stop severe hemorrhage; then an analgesic (morphine) was injected subcutaneously into the injured leg to prevent shock. In addition, the heart stimulating drugs were injected. However, despite the morphine injection the patient kept groaning of pain and suffered from progressing shortness of breath. The patient's blood pressure was 60/35 mm Hg, pulse rate 126/min. Auscultation of the lungs revealed frequent and depressed breathing on the left side; no sounds were detected on the right side. The consciousness became obtunded. Cyanosis of the skin and mucosal membranes was progressing. The doctor subcutaneously injected a drug stimulating the respiratory center to activate breathing. However, it had no effect, and the patient lost consciousness.

Questions: