SKENARIO
5 – SCENARIO ENGLISH
Author:
Amina, Shiddiq, Venty
A
30-year-old man comes to a clinic. He has a fever, headache, and epigastric
pain. He has been very busy with his work these days, therefore he cannot have
his lunch timely. Doctor gives him two kinds of medicines. He has to take one
of them before his meal and the other one after his meal.
CLARIFYING
UNFAMILIAR TERM
· Fever : an abnormally high body
temperature, usually accompanied by shivering, headache, and in severe
instances, delirium. A high body temperature or a state of nervous excitement
in someone.
·
Headache : a continuous pain in the
head.
·
Epigastric Pain : epigastric pain is a
pain that localized to the region of the upper abdomen immediately below the
ribs.
PROBLEM
DEFINITION
1. What
is an epigastric pain?
2.
What is the connection between not
having a lunch timely with epigastric pain?
3.
What is the function of the medicines
that he takes before and after his meal?
4.
What
is fever?
5.
What is the mechanism of fever and
headache?
6. What is the home care that should
takes when a person get fever?
ANALYZING
1.
What
is an epigastric pain?
first sources
Epigastric
pain is pain that localized to the region of the upper abdomen immediately
below the ribs. Epigastric pain may occur with conditions that cause
inflammation of the digestive organs, such as gastritis and pancreatitis.
Epigastric pain is not a serious symptom on its own. However, if it occurs with
other life-threatening symptoms, it may be a sign of a condition that should
receive immediate medical treatment. Most commonly, epigastric pain is the
result of overeating, drinking alcohol while eating, or consuming greasy or
spicy foods. Other causes of epigastric pain is acid reflux or peptic ulcer. Epigastric pain may be
dull or burning. It may spread upward to the chest or to the back. There may be
other symptoms such as belching, bloating, cramps, or hunger pains. There may
be weight loss or poor appetite, nausea or vomiting. We can reduce the
epigastric pain by consume antacids (Mylanta or Maalox) to help neutralize
stomach acid, avoid foods that irritate the stomach, and avoid alcohol,
caffeine and tobacco.
second sources
Epigastric pain can be a sign of disease
in the upper abdomen. Common causes include:
·
Acid reflux (stomach acid flowing up
into the esophagus)
·
Gastritis (irritation of the stomach
lining)
·
Peptic Ulcer Disease
·
Inflammation of the pancreas
·
Gallstone
·
Infection in the gall bladder
Pain may be
dull or burning. It may spread upward to the chest or to the back. There may be
other symptoms such as belching, bloating, cramps or hunger pains. There may be
weight loss or poor appetite, nausea or vomiting.
Since the
diagnosis of your pain is not certain yet, further tests will be needed.
Sometimes the doctor will treat you for the most likely condition to see if
there is improvement before doing further tests
2.
What
is the relation between not having a lunch timely
with epigastric pain?
One
of the causes of epigastic pain is peptic ulcer. If peptic ulcer is happen in
stomach, it’s called as gastric ulcer. Your stomach normally produces acid to
help with the digestion of food and to kill bacteria. This acid is corrosive,
so some cells on the inside lining of the stomach and duodenum produce a
natural mucus barrier which protects the lining of the stomach and duodenum.
There is normally a balance between the amount of acid that you make and the
mucus defense barrier. An ulcer may develop if there is an alteration in this
balance, allowing the acid to damage the lining of the stomach or duodenum.
Causes of this include the following:
Infection with Helicobacter pylori
Infection by Helicobacter pylori (commonly
just called H. pylori) is the cause in about 8
in 10 cases of stomach ulcer. More than a quarter of people in the UK become
infected with H. pylori at some stage in
their life. Once you are infected, unless treated, the infection usually stays
for the rest of your life. In many people it causes no problems and a number of
these bacteria just live harmlessly in the lining of the stomach and duodenum.
However, in some people this bacterium causes an inflammation in the lining of
the stomach or duodenum. This causes the defence mucus barrier to be disrupted
(and in some cases the amount of acid to be increased) which allows the acid to
cause inflammation and ulcers.
Anti-inflammatory drugs - including aspirin
Anti-inflammatory drugs are sometimes called non-steroidal
anti inflammatory drugs (NSAIDs). There are various types and brands. For
example: aspirin, ibuprofen, diclofenac, etc. Many people take an
anti-inflammatory drug for arthritis, muscular pains, etc. Aspirin is also used
by many people to protect against blood clots forming. However, these drugs
sometimes affect the mucus barrier of the stomach and allow acid to cause an
ulcer. About 2 in 10 stomach ulcers are caused by anti-inflammatory drugs.
Other Causes and Factors
Other causes are rare. For example, some viral infections
can cause a stomach ulcer. Crohn's disease may cause a stomach ulcer in
addition to other problems of the gut. Stomach cancer may at first look similar
to an ulcer. Stomach cancer is uncommon, but may need to be 'ruled out' if you
are found to have a stomach ulcer.
When we are hungry or when our
gaster is empty, gaster will automatically produce digestive enzyme. This
digestive enzyme is acidic, and with this acid the function of gaster will
work. This acid will broke down the food into another simplified substance. But
from this gaster acid the pain in stomach come. This acid if meet with gater
mucus that already irritated will cause epigastric pain. Wrong diet for example
irregular eating patterns (often late meal) will cause gastric fluid has been
available to digest food even irritate the gastric mucosa itself. If the
irritation is occurring continuously the over time will cause damage to the
gastric mucosa to the onset of heartburn symptoms. Gastric mucosa has been
damaged would be more sensitive to the presence of gastric acid. The increase
stomach acid levels will be a little trigger heartburn because stomach acid
would stimulate pain especially in the mucosal lining of the stomach that has
been damaged. That is why the factors of gastric acid plays an important role
in heartburn. Excessive stomach acid is often associated with the onset of
heartburn symptoms.
3.
What
is the function of the medicines that he takes before and after his meal?
Usually
to relieve or cure the patient should take the drug if necessary. But the ulcer
can be prevented, that is by eating regularly, eating, wash hands before eating
and do not snack at random.
Medicines
for heartburn is generally eaten two hours before a meal and two hours after
meals. As for the purpose of drug consumed two hours before the meal is to
neutralize stomach acid, because at the time the accumulation is very much
gastric acid in the stomach and the patient must have been minor injuries when
exposed to acids which will feel sore. Then the drug is taken two hours after
meals aims to protect the stomach wall from acid continues to be produced.
Finally, two hours after eating, the acid in the stomach will be used to digest
the food that has been neutralized and will not injure the walls of the
stomach.
The
drugs are usually used:
1.
Antacids (Neutralize stomach acid and relieve pain)
2.
Pankreatin (Helps digestion of fats, carbohydrates, proteins and overcome pain
digestive disorders such as flatulence, nausea, and often out of gas)
3.
Ranitidine (Treating stomach ulcers)
Because
when the stomach is empty, increased gastric acid production, and guard against
substances in the foods we eat, which has the potential to stimulate the
production of stomach acid.
Generally
diabrospri drug in the small intestine because the surface is very extensive ,
and only a small fraction of drug absorbed in the stomach .
Fast
or slow the absorption process , heavily influenced by various factors , one of
which is a factor of food . The existence of these foods , can cause drug
interactions . As a result of these interactions , can occur where there are
drugs that absorption is impaired by the presence of food , there are actually
helped with the food , and there are not affected by the presence / absence of
food . Circumstances like these are the reason why the drug should be taken
before meals or even drink after a meal .
There
are several considerations , reasons and on the basis of the most appropriate
time to take medicine , especially medicinal properties as well as medicinal
purposes .
•
Take medication before eating
In general,
and in essence , a drug taken before a meal ( on an empty stomach ) , because
the presence of food can interfere with the process experienced by the drug
before the drug is absorbed into the blood and provide benefits . Drugs taken
before meals if the drug is not irritate the stomach . Magh certain drugs taken
to control stomach acid is also taken before meals . But the basic principle is
not applicable and a current of certain drugs ( such as will be described in
the next bullet point).
•
Take medication after meals
Drugs taken
after meals for several reasons . One of them is if the drug is taken to be
irritating to the stomach and digestive tract , so that use of the drug after
meals to minimize this .
•
Take medications at meal times
Some specific
drugs become damaged and do not function when in contact with stomach acid .
There is also a drug used for the purpose of helping the process of digestion
of food and absorption of nutrients from food . Or there are also certain
medications which farmakokinetika process better by the presence of food in the
digestive tract . Well , with medications such as the nature and purpose of use
is given at meals or with food
•
Take medications in the morning , at night before bed , and the other time
Diuretics (
which cause frequent urination ) should be taken in the morning . Why not
night? Because you do not want it you have disturbed sleep because of the need
to go to the bathroom every hour of his ? In addition there are other
medications that also have a special time to drink it .
4.
What is Fever?
Fever is the temporary increase in
the body's temperature in response to some disease or illness.
A child has a fever when the
temperature is at or above one of these levels:
·
100.4 °F (38 °C) measured in the bottom
(rectally)
·
99.5 °F(37.5 °C) measured in the mouth (orally)
·
99 °F (37.2 °C) measured under the arm
(axillary)
An adult probably has a fever when
the temperature is above 99 - 99.5 °F (37.2 - 37.5 °C), depending on the time
of day.
Consideration
Normal body
temperature may change during any given day. It is usually highest in the
evening. Other factors that may affect body temperature are:
·
In the second part of a woman's menstrual cycle,
her temperature may go up by 1 degree or more.
·
Physical
activity, strong emotion, eating,
heavy clothing, medications, high room temperature, and high humidity can all
increase your body temperature.
Fever is an important part of the
body's defense against infection. Most bacteria and viruses that cause
infections in people thrive best at 98.6 °F. Many infants and children develop
high fevers with minor viral illnesses. Although a fever signals that a battle
might be going on in the body, the fever is fighting for the person, not
against.
Brain damage from
a fever generally will not occur unless the fever is over 107.6 °F (42 °C).
Untreated fevers caused by infection will seldom go over 105 °F unless the
child is overdressed or trapped in a hot place.
Febrile seizures
do occur in some children. However, most febrile seizures are over quickly, do
not mean your child has epilepsy, and do not cause any permanent harm..
Unexplained fevers
that continue for days or weeks are called fevers of undetermined origin (FUO).
5.
What
is the mechanism of fever and headache?
Mechanism of Fever
The term fever refers to an elevation
in body temperature as a result of infection or inflammation. In response to
microbial invasion, certain phagocytic cells (macrophages) release chemicals
that act as an endogenous pyrogen, which, among its many infection-fi ghting eff
ects, acts on the hypothalamic thermoregulatory center to raise the thermostat
setting (● Scheme below). Th e hypothalamus now maintains the temperature at the new
set level instead of maintaining normal body temperature. If, for example,
endogenous pyrogen raises the set point to 102°F (38.9°C), the hypothalamus senses
that the normal prefever temperature is too cold, so it initiates the
cold-response mechanisms to raise the temperature to 102°F. Specifi cally, it
initiates shivering to rapidly increase heat production, and promotes skin
vasoconstriction to rapidly reduce heat loss, both of which drive the
temperature upward. Th ese events account for the sudden cold chills oft en experienced
at the onset of a fever. Feeling cold, the person may voluntarily put on more
blankets to help raise body temperature by conserving body heat. Once the new
temperature is achieved, body temperature is regulated as normal in response to
cold and heat but at a higher setting. Th us, fever production in response to
an infection is a deliberate outcome and is not caused by a breakdown of
thermoregulation. Although the physiologic signifi cance of a fever is still
unclear, many medical experts believe that a rise in body temperature has a
benefi cial role infi ghting infection. A fever augments the infl ammatory response
and may interfere with bacterial multiplication. During fever production,
endogenous pyrogen raises the set point of the hypothalamic thermostat by triggering
the local release of prostaglandins, which are local chemical mediators that
act directly on the hypothalamus. Aspirin reduces a fever by inhibiting the
synthesis of prostaglandins. Aspirin does not lower the temperature in a
nonfebrile person, because in the absence of endogenous pyrogen, prostaglandins
are not presentin the hypothalamus in appreciable quantities.
Infection or inflammation ®
+ Macrophages ® + Endogenous
pyrogen ® the
increase of Prostaglandins ®
↑Hypothalamic set point ®
Initiation of “cold response” ®
↑Heat production; ↓heat loss ®
Body temperature to new set point = Fever
● Scheme (Photo:
L. J. Le Beau/ Biological Photo Service.)
Th e
exact molecular cause of a fever “breaking” naturally is unknown, although it
presumably results from reduced pyrogen release or decreased prostaglandin
synthesis. When the hypothalamic set point is restored to normal, the
temperature at 102°F (in this example) is too high. Th e heat-response
mechanisms are instituted to cool down the body. Skin vasodilation occurs, and sweating
commences. Th e person feels hot and throws off extra covers. The gearing up of
these heat-loss mechanisms by the hypothalamus reduces the temperature to
normal.
Causes of fever
Fever is a symptom not a disease. Fever is a response
normal body against infection. Infection is the inclusion of state
microorganisms into the body. Microorganisms can be a virus, bacteria,
parasites, and fungi. Most fevers are caused by infections virus. Fever can
also be caused by exposure to excessive heat (overhating), dehydration,
allergies or due immune system disorders (Lopez, 2009)
Almost any infection can cause a
fever. Some common infections are:
·
Infections
such as pneumonia, bone infections (osteomyelitis), appendicitis, tuberculosis,
skin infections or cellulitis, and meningitis
·
Respiratory
infections such as colds or flu -like illnesses, sore throats, ear infections,
sinus infections, infectious mononucleosis, and bronchitis
·
Urinary
tract infections
·
Viral
gastroenteritis and bacterial gastroenteritis
Children may have a low-grade fever
for 1 or 2 days after some immunizations.
Teething may cause a slight increase
in a child's temperature, but not higher than 100 °F.
Autoimmune or inflammatory disorders
may also cause fevers. Some examples are:
·
Arthritis
or connective tissue illnesses such as rheumatoid arthritis and systemic lupus
erythematosus
·
Ulcerative
colitis and Crohn's disease
·
Vasculitis
or periarteritis nodosa
The first symptom of a cancer may be
a fever. This is especially true of Hodgkin's disease, non-Hodgkin's lymphoma,
and leukemia.
Other possible causes of fever
include:
·
Blood
clots or thrombophlebitis
·
Medications,
such as some antibiotics, antihistamines, and seizure medicines
Cause of headaches
Skipping
lunch à
Empty stomach because no time to eat lunch at some people often cause
headaches. In addition to dizziness, empty stomach also makes the blood sugar
down, consequently the body felt weak. Immediately lunch with balanced
nutrition. Avoid eating sweet foods, such as chocolate to fill an empty
stomach. Sugar from sugary foods will make your blood sugar to soar then fall
even lower.
6. What is
the home care that should takes when a person get fever?
A simple
cold or other viral infection can sometimes cause a high fever (102 - 104 °F,
or 38.9 - 40 °C). This does not usually mean you or your child have a serious
problem. Some serious infections may cause no fever or even a very low body
temperature, especially in infants.
If the
fever is mild and you have no other problems, you do not need treatment. Drink
fluids and rest.
The illness is probably not serious
if your child:
·
Is
still interested in playing
·
Is
eating and drinking well
·
Is
alert and smiling at you
·
Has
a normal skin color
·
Looks
well when their temperature comes down
Take steps to
lower a fever if you or your child is uncomfortable, vomiting, dried out
(dehydrated), or not sleeping well. Remember, the goal is to lower, not
eliminate, the fever.
When trying to lower a fever:
·
Do
NOT bundle up someone who has the chills.
·
Remove
excess clothing or blankets. The room should be comfortable, not too hot or
cool. Try one layer of lightweight clothing, and one lightweight blanket for
sleep. If the room is hot or stuffy, a fan may help.
·
A
lukewarm bath or sponge bath may help cool someone with a fever. This is
especially effective after medication is given -- otherwise the temperature
might bounce right back up.
·
Do
NOT use cold baths, ice, or alcohol rubs. These cool the skin, but often make
the situation worse by causing shivering, which raises the core body
temperature.
Here are some guidelines for taking
medicine to lower a fever:
·
Acetaminophen
(Tylenol) and ibuprofen (Advil, Motrin) help reduce fever in children and
adults. Sometimes doctors advise you to use both types of medicine.
·
Take
acetaminophen every 4 - 6 hours. It works by turning down the brain's
thermostat.
·
Take
ibuprofen every 6 - 8 hours. DO NOT use ibuprofen in children younger than 6
months old.
·
Aspirin
is very effective for treating fever in adults. DO NOT give aspirin to a child
unless your child's doctor tells you to.
·
Know
how much you or your child weighs, and then always check the instructions on
the package.
·
In
children under age 3 months, call your doctor first before giving medicines.
Eating and drinking with a fever:
·
Everyone,
especially children, should drink plenty of fluids. Water, popsicles, soup, and
gelatin are all good choices.
·
Do
not give too much fruit or apple juice and avoid sports drinks in younger
children.
·
Although
eating foods with a fever is fine, do not force foods.
References
·
Sherwood
L. Human physiology 7th ed. from
cell to cell Canada : Brooks/Cole Cengage Learning; 2007.
sub sources
·
Mick NW. Pediatric fever. In: Marx
JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed.
Philadelphia, Pa: Mosby Elsevier;2009:chap 165.
·
Legget J. Approach to fever or
suspected infection in the normal host. Goldman L, Ausiello D, eds. Cecil
Medicine, 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 302.
Author:
Amina, Shiddiq, Venty
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