Discuss how the gastric abnormalities contribute to vitamin B12 and iron deficiency and how vitamin B12 deficiency causes complications associated with pernicious anemia.

Mr. X, age 57, presented to his physician with marked fatigue, nausea with occasional diarrhea, and a sore, swollen tongue.

Mr. X, age 57, presented to his physician with marked fatigue, nausea with occasional diarrhea, and a sore, swollen tongue.

Lately he also has been experiencing a tingling feeling in his toes and a feeling of clumsiness.

Microscopic examination of a blood sample indicated a reduced number of erythrocytes, many of which are megaloblasts, and a reduced number of leukocytes, including many large, hypersegmented cells. Hemoglobin and serum levels of vitamin B12 were below normal.

Additional tests confirm pernicious anemia.

Discussion Questions

Relate the pathophysiology of pernicious anemia to the manifestations listed above.

Discuss how the gastric abnormalities contribute to vitamin B12 and iron deficiency and how vitamin B12 deficiency causes complications associated with pernicious anemia.

Discuss other tests that could be performed to diagnose this type of anemia.

Discuss the treatment available and the limitations.

Ms. L, a 19-year-old woman with no previous medical history, was involved in a serious automobile accident in which her best friend died.

Examination by EMT personnel first on the scene revealed she had only minor scrapes and bruises and no sign of head trauma.

While en route by ambulance to the hospital, Ms. L complained of thirst and appeared restless.

Further examination indicated a rapid pulse and respirations, with her blood pressure now at 100/60 mm Hg.

She appeared less responsive to the paramedics.

She was slipping into circulatory shock as they checked her again for internal injuries.

Discussion Questions

Discuss the contributing factors to shock in this case and the pathophysiologic changes causing the changes in vital signs.

Discuss the signs and symptoms of shock, including the rationale for each, as seen in the early stage, and as compensation mechanisms respond.

Discuss emergency and follow-up treatment for shock and for complications that may arise if not treated quickly.

Compare the types of shock, giving a specific cause, classification, and any significant changes in onset or manifestations.

Weekly Outcomes:

Articulate alterations in structure and function of the cardiovascular and hematologic systems. (CO 1)

Trace the impact that alterations in the cardiovascular and hematologic systems have on the body. (CO 2)

Summarize the impact of alterations in the cardiovascular and hematologic systems on homeostasis. (CO 3)

Weekly Objectives:

Understand normal cardiovascular system disorders.

Compare and contrast common cardiovascular conditions: causes, clinical manifestations, diagnostic tests, and treatments.

Apply understanding of alterations in and cardiovascular systems across the lifespan to formulate care priorities.

Examine responses to aging and its impact on pathophysiologic changes in the cardiovascular system.

Describe how heredity and genetics influence pathophysiological alterations in the cardiovascular system.

Understand hematologic response to illness and injury. Examine factors leading to cancers of the hematologic system.

Compare and contrast common types of anemias: causes, clinical manifestations, diagnostic tests, and treatments.

Apply understanding of alterations in the hematologic system across the lifespan to formulate care priorities.

Apply growth and development principles as they relate to the impact of aging on pathophysiologic changes.

Describe how genetics influence pathophysiological alterations in the hematologic system.

Main Topics and Concepts Alterations in the cardiovascular system: perfusion

Alterations in physical structures and functions

Alterations in cardiac system function

Pathophysiologic cardiovascular system response to aging

Congenital and genetic influences on cardiovascular system pathology

Alterations in the hematology system Hematologic response to illness and injury

Cancers of the hematologic system

Pathophysiologic hematologic system response to aging

Genetic influences on hematologic system pathology

Sub-Concepts with Exemplar:

Fluid imbalances:

pulmonary edema;

congestive heart failure Metabolism:

metabolic syndrome Perfusion:

pulmonary embolism;

heart disease;

hypertension;

venous versus arteriole disorders;

and shock states

Aging process:

chronic leukemia

Acute versus chronic conditions

Cellular adaptation:

acute leukemia Perfusion:

polycythemia Oxygenation:

anemias and hemoglobin and hematocrit levels Genetics:

hemophilia A, chronic myeloid leukemia (CML) Injury:

disseminated intravascular coagulation (DIC)