1. Major clinical problem
The major clinical problem for Mr. S. is Melena. Melena refers to feces that are tarry and dark black in colorcaused by the bleeding of upper gastrointestinal tract. The black color and strong smell of the feces is caused by the presence of hemoglobin in blood that is being altered by the intestinal bacteria and digestive enzymes (Katzung, 2017). The most likely for this condition is the bleeding of the upper gastrointestinal tract.
The following are the physical and lab findings that show the presence of melena. Firstly, there is stool which is sticky, black and malodorous signifying the presence of blood caused by gastrointestinal bleeding. Secondly, tests carried out on the rectum showed the presence of black tarry stools.
2. Differential diagnosis
· After examination, Mr. S. was feeling pain under the ribs around his upper abdomen. This indicated severe bleeding of the abdomen.
· Mr. S. was treated with hypertension in the past which showed that he had a bleeding blood vessel in his body that caused the high blood pressure.
The bleeding leads to the formation of melena an indication of duodenal ulcer.
· Mr. S. was once notified of the presence ulcers which were not evaluated. Lack of treatment during the early stages of cancer worsened the situation leading to excessive bleeding that might have caused duodenal ulcers.
· Mr. S. has been using Aspirin that makes him vulnerable to duodenal ulcers. The use of USAID’s also predisposes him to duodenal ulcers.
· Excessive drinking and smoking that Mr. S. has been engaging in predisposes him to duodenal ulcers. This leads to cirrhosis that causes bleeding. The bleeding might be happening in the duodenum resulting into duodenal ulcer (Lasota, 2018).
· Increased level of bun which signifies a reduction in the volume of blood. This shows that there has bleeding that has resulted into duodenal ulcers. · The presence of lightheadedness, cool and moist skin and the formation of melena show the presence of duodenal ulcers.
· There is the presence of digested blood that causes the formation of melena.
· Egestion of black and tarry stool signifies the presence of bleeding that causes gastric acid.
· Mr. S. reported the presence of chronic epigastric burning that is caused by the presence of gastric acid in the stomach. This causes peptic ulcers thus increasing the possibility of its presence (Mann, 2017).
· Reduced blood volume shows that there has been loss of blood caused by the bleeding in the gastrointestinal tract. Mr. S. has no surgeries or blood transfusion in the past; therefore, low blood volume shows that there has been internal bleeding that has led to the development of gastric acid. 3. Physical findings and historical information
The physical findings that I will be looking for Mr. S. situation include:
· Hypovolemic manifestation
ü Mr. S. was having the feeling of anxiety, lightheadedness and he was restless during the examination.
ü He also had a pale and moist skin. This showed that he had lost too much blood caused by the excessive bleeding in the gastrointestinal tract.
ü He was having peripheral pulses which are weak. This indicated the reduced volume of blood that was caused by the excessive bleeding of the GI tract (Holland, 2015).
ü Orthostatic. This is excessive loss of blood. It may be as a result of GI bleeding that leads to formation of melena.
· Findings that were found in cirrhosis showed the possibility of esophageal varices to be the cause of bleeding which signified the presence of peptic ulcers. This was indicated by full parotid glands, spider nevi, splenomegaly, hepatomegaly and ascites.
· There was also a finding showing hemorrhagic telangiectasia that is hereditary. This might also be cause of bleeding experienced by Mr. S.
· Oropharynx should also be examined carefully to identify if there is any other area that is bleeding.
The historical information that I will gather for Mr. S. situation include:
ü Hypovolemic symptoms which include lightheadedness.
ü I will found out if Mr. S. has ever suffered from nose bleeding.
ü I will gather information about the stool that Mr. S. egesting which include whether the stool was black, foul smell and sticky.
ü I will gather information concerning the intake of iron supplements and licorice.
ü I will information about smoking habit and previous drinking of alcohol.
ü I will information about the surgery of the aorta and the presence of portal hypertension (Seymour, 2014).
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