ANEMIA SECONDARY TO LOWER GASTROINTESTINAL BLEEDING SECONDARY TO RADIATION PROCTOCOLITIS T/C METASTASIS CERVICAL CANCER

Mia is a 55 year old, married, female and a naturalborn Filipino who lives in Pampanga. Admitted in a private hospital on September 29, 2012 at 3:15 in the afternoon with chief complaints of rectal bleeding, dizziness and vomiting with admitting diagnosis of Anemia secondary to Lower Gastrointestinal Bleeding; T/C Metastasis Cervical Cancer.

born on October 9, 1953 finished her secondary education with three children all born via normal spontaneous delivery. prefers eating meat rather than vegetables of cervical cancer in 2010 no vices

stressor in life is the job of his eldest son who works as a driver of an armoured van at the Bank Of the Philippine Islands believes in hilot uses herbal plants self-medicate with over the counter drugs plain housewife

HISTORY OF PAST ILLNESS

chicken pox, mumps, and sore eyes headache, muscle pain, flu, coughs and colds February of 2010, noticed streaks of blood in her underwear pap smear and tissue sample were taken for biopsy treatment began in April 2010 chemotherapy and brachytherapy

July 2010-patient is free of cervical cancer August 22, 2012 : admitted due to bloody stool endoscopy report: Radiation Proctocolitis

September 29, 2012-few hours prior to admission, the patient experienced persistent rectal bleeding ,dizziness and non-projectile vomiting. Her vomitus is coffee ground in color, and approximately 50 ml.

PHYSICAL EXAMINATION UPON ADMISSION

Temperature: 37.5C Pulse Rate: 104 bpm Respiratory Rate: 24 bpm Blood Pressure: 80/40 bpm Skin: (+) pallor, (-) jaundice, (-) cyanosis Head:, EENT: Pale palpebral conjunctiva, negative cervical lymp adenpathy Chest, Lungs: Symmetrical chest expansion, (-) retractions Heart: Adynamic precordium, tachycardia, (-) thrills, (-) murmur Abdomen: Globular, soft, normal and active bowel sounds, non-tender Extremities: Pale nail beds, cold upper and lower extremities (-) cyanosis, weak peripheral pulses Neurological: No found neurological deficits Rectal Exam: No haemorrhoids, no fissures, no masses, palpated, no tenderness, intact rectal vault, good sphincter tone.

SOCIAL STATUS MENTAL STATUS EMOTIONAL STATUS SENSORY STATUS MOTOR STABILITY TEMPERATURE RESPIRATORY STATUS

CIRCULATORY STATUS NUTRITIONAL STATUS: ELIMINATION REPRODUCTIVE STATE OF PHYSICAL REST AND COMFORT STATE OF SKIN AND APPENDAGES

DIAGNOSTICS
CBC WBC-0 9/29/12 17.8

10/03/12 16.9 10/05/12 17.4 10/09/12 13.8 NORMAL VALUES-5-10x109/L

Hemoglobin (Hgb) 09/29/12-33 g/L 10/03/12-111 g/L 10/05/12-106 g/L 10/09/12-77 g/L NORMAL VALUES-115-155 g/L

Hematocrit 09/29/12-0.10 10/03/12-0.23 10/05/12-0.34 10/09/12-0.35

PROTHROMBIN TIME
09/30/2012 It measures how long it takes for the blood to start clotting. It is used to evaluate the adequacy of the extrinsic system and common pathway in clotting mechanism.

Patient= 17.3 secs. Control=13.3 Activity=57.3% INR=1.02 NORMAL VALUES

Patient=12-15 secs Activity= 70-100%

PARTIAL THROMBOPLASTIN TIME

09/30/12 10/05/12 The partial thromboplastin time test is a blood test that is done to investigate bleeding disorders and to monitor patients taking an anti-clotting drug. Used to evaluate all the clotting factors of the intrinsic pathway.

PATIENT 34.1 31.9 NORMAL VALUES 35-45 secs PTT is shorter. This could suggest that there are too many or rapid formation of coagulation factors, prothrombin and fibrinogen.

PLATELET COUNT

10/03/12-120 10/05/12-64 10/09/12-46 NORMAL VALUESThe patients platelet count level is decreased, which indicates that bleeding has occured thus intrinsic pathway or clotting factors will be the one to form the clot because of severe damage of leaflets. Platelet plug forms from extrinsic pathway and platelet will only be elevated or decreased if there is tear of blood vessel resulting to wound in the tissue thus platelet plug will form.

ELECTROCARDIOGRAM

Sinus tachycardia

MEDICAL MANAGEMENT

PNS 1 L x 30-31 Gifts/min

PNSS 1L x KVO Fast drip 500 cc now then regulate

It is usually used in restoring and maintaining fluids and electrolyte balance.

NGT (NASOGASTRIC TUBE FEEDING)

The Nasogastric tubes serve to purposes to the patient. First it was ordered to detect bleeding in the upper GIT of the patients by aspiring gastric contents. Second it was ordered to feed the patient parenterally with Nutren Fibre(Nutren Fibre is a complete high energy diet for people who are having difficulty eating due to illness. It also provides more of the fibre they need).

BLOOD TRANSFUSION

Components: Packed Red Blood Cell 1st 09/29/12

2nd 10/05/12

3rd

10/09/12

Patient was pale in color, which is a sign of inadequate tissue perfusion delivery. Patient has haemoglobin level of less than 115 g/L and active bleeding occurs leading to hypoxia. The therapeutic goal or purpose of the blood transfusion is to increase oxygen delivery and to replace the blood components required for the homeostasis of the coagulation process.

O2 INHALATION VIA NASAL CANNULA AT 3 LPM

10/02/12-10/08/12
It is used to treat or prevent symptoms and manifestations of hypoxia

OMEPRAZOLE
09/29/2012 40 mg IV q12 Reduces the risk of GI bleeding in critically ill patients. The drug was given to the patient because she was experiencing the upper GI bleeding.

DIPHENHYDRAMINE
09/29/12 10/05/12 10/09/12 50 mg IV prior to BT The drug was given prior to BT to prevent allergic reactions that may occur.

TRANEXAMIC ACID
09/30/12 Up t0 10/07/12 The drug was given to the patient for short term control of bleeding.

SUCRALFATE
10/06/12 1 gm 2 tabs OD Decreases the patients gastric secretion and treatment of peptic ulcer and GERD

VITAMIN K
10/02/12 1 amp IV now then q8 Anticoagulant and used in the prevention and treatment of vitamin deficiencies.