MHS1102: Anatomy and Physiology | Case Study

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MHS1102 CASE STUDIESCase 1Mr Andrews is a 63-year old man who has had variety of medical problems during the past 5years. He has been treated for two myocardial infarctions, hypertension, non-insulindependent diabetes and dermatitis of the left leg. He had an aorto-coronary bypass one yearago.Most recently he has been experiencing shortness of breath which has been more noticeableover the past five days. He tires easily and reports that the ‘has lost the energy to doanything’. He also complains of anorexia. Last night he awoke suddenly from sleep becausehe could ‘catch his breath’ and developed a dry cough. The breathing problem improvedwhen he sat on the edge of his bed for an hour. He generally sleeps with two, sometimesthree pillows. He has not experienced chest pain, leg pain or fainting spells. When hepresents at the GP, his breathing is laboured and his lips have a blue tinge and his hands arecold to the touch. He is also noticeably sweating [diaphoretic].His blood pressure is 98/82mmHg and he has a heart rate of 110/minutes. The GP also notesthat his heart sounds [S1, S2] are diminished and she detects an abnormal third hear sound.Examination of the cardiovascular system showed that his neck veins are prominent andpulsatile, and distended to the mandible when the patient is sitting upright. The apex beat ofthe heart is palpated in the 5thintercostal space. Examination of this lungs shows dullness atthe base of each lung.Examination of the abdomen showed that the anterior wall is round and soft. The liver edgeis palpable and tender, but the spleen is not palpable. Examination of the extremitiesrevealed diminished irregular peripheral pulses, and there is pitting oedema of both lowerextremities.The patient is diagnosed with congestive heart failure.Choose 10 [ten] of the symptoms experienced by the patient and, using your anatomical andphysiological knowledge of the cardiovascular system, explain these symptoms and outlinehow each of these is indicative of, and would support a diagnosis of congestive heart failure.[20 marks]
Case 2An ice skater and her partner are practising their routine in preparation for upcoming localchampionships. Part of their routine involved an aerial spin, after which her partner wouldcatch her.Unfortunately, the pair mistimed the routine and the skater fell heavily on her left side ontothe ice. The skater was doubled up in pain. She described particularly severe pain in thelateral posterior region of her trunk, between the left costal margin and the iliac crest.She was taken to the emergency room and examined. Plain film X-rays showed a fracture ofRib11, and that the margin of the left psoas major muscle was not distinguishable. Urinalysisshowed blood in her urine. An intravenous pyelogram [IVP] and CT scans were done.TheIVP showed leakage of contrast media into the tissue immediately around the kidney. Thehaemorrhage was confined to the area immediately around the kidney and extended mediallytoward the abdominal aorta.The diagnosis was laceration or rupture of the kidney. Surgery was performed to close thelaceration.Questions1. Describe the gross anatomy of the left kidney. Outline its anatomical location and itsrelations to explain how this injury could also involve Rib 11 and the psoas major muscle. [9marks]2. Explain why pain in the kidney would be experienced in the area described by the skater.[1]3. Explain why the margin of thepsoas major muscle was not visible on the x-ray. [2 marks]4. Based on your knowledge of kidney anatomy, explain how or why blood was found in theurine. [2 marks]5. Briefly outline the process involved in performing an IVP. [2 marks]6. Using your anatomical knowledge of the kidney, explain how the haemorrhage wasconfined to the area around the kidney. [3 marks]7. Explain why it is possible to perform surgery on the kidney without penetrating theperitoneal cavity. [1 mark]
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