The Blood Pressure Mystery

http://discovermagazine.com/2008/apr/16-blood-pressure-mystery

Summary:
A man, Mr. Dexter, came into the emergency room with a blood pressure of 66 over 40 and short breath and nausea. He had in the past had an obesity surgery but other than that no major medical history problems. He was given 3 liters of saline and dopamine(a blood pressure booster), but no change occurred. The doctors were confused and there was no fever, headache, chest pain, or abdominal pain. The EKG showed no signs of a heart attack, a thought was that maybe the ventricle wall wasn't contracting correctly. The three major possible causes of low blood pressure are pump failure, leaky blood vessels, or fluid loss. With a systolic pressure of 66, he was losing blood. The most common source to find leaking blood is in the GI tract, but the GI tract was clean. The doctors then looked at Morison's pouch, where the kidneys and liver meet. Sure enough the ultrasound found fluid in the abdomen. But there was no reason for Dexter to have ascites, the accumulation of fluid in the abdomen. The blood can irritated the lining of the abdomen and cause pain in the belly. But He had a small amount of belly pain when the doctors pushed on his belly, but no excruciating pain. Dexter should not have blood in his belly with his minimal pain. Since his gastric bypass surgery, his abdomen was anatomically different. The doctors had many theories for the belly to have blood in it but all the symptoms were normal. Then the blood pressure read 110 over 60 which made Dexter stable enough to have a CT scan. The doctors were looking for a clot, but instead found blood everywhere. The CT scan also found what was thought to be a tumor or an aneurysm.

Aneurysms are caused by a malformation of the blood vessel. Most produce symptoms of a common infection or a migraine. These cause hemorrhages and can burst at any time. A type of aneurysm is the splenic artery aneurysm. Pregnant women in the third trimester are at risk with the increases in blood pressure. Most symptoms mimic stomach viruses.

Doctors ruled out the the tumor and the aneurysm. Dexter had a splenic peliosis, which is blood-filled cavities within the parenchyma, which can burst at any time. Splenic peliosis is very rare. The reason he had no symptoms is because the adhesion from the surgery stuck his intestines against the walls of the abdomen causing the blood to flow to the sides. After an operation to correct the problem, Dexter went to intensive care and was lucky to live.

Response:
Wow, to think of how many factors can effect our blood pressure. I am just amazed with the skills of the doctors to know and find out these mysteries. This just shows how complicated our bodies are and it makes you thank God that there aren't more complications. Even when we have problems God is there to provide a way out for us.