Assignment: Advanced physiology and pathophysiology

Assignment: Advanced physiology and pathophysiology

Mr. K.P. is a 71-year-old male, who presents to your office with a 3-day history of more than 103F with chills. The patient reports, “I don’t feel well, and I think that I may have the flu.” He also complains of “some painful bumps on my fingers and toes that came on last night.” He denies IVDA. When asked about recent medical or dental procedures, he responds: “I had an infected tooth removed about 2 weeks ago.” He does not recall receiving any antibiotics either prior to or after the procedure.

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PMH:

• Asthma since childhood
• Rheumatic fever as a child x 2 with mitral valve replacement 2 years ago
• HTN x 20 years
• DM type 2, x 9 years
• COPD x 4 years
• H/O tobacco abuse
• Alcoholic liver disease

Urinalysis: The urine was pale yellow, clear, and negative for proteinuria and hematuria. A urine toxicology screen was also negative.

ECG: Normal

Transthoracic ECHO: A 3-cm vegetation on the aortic valve was observed. No signs of ventricular hypertrophy or dilation were seen.

Blood Cultures: 3 of 3 sets (+) for Streptococcus viridans (collection times 1030 Tuesday, 1230 Tuesday, 1345 Tuesday)

 Laboratory Blood Test Results

• Na 135 meq/L
• K 3.7 meq/L
• Cl 100 meq/L
• HCO3 22 meq/L
• BUN 17 mg/dL
• Cr 1.0 mg/dL
• Glu, random 145 mg/dL
• Hb 14.1 g/dL
• Hct 40%
• Plt 213,000/mm3
• WBC 19,500/mm3
• Neutros 80%
• Bands 7%
• Lymphs 12%
• Monos 1%
• Alb 4.0 g/dL
• ESR 30 mm/hr
• Ca 8.9 mg/dL

Questions

1. Which type of infective endocarditis is suggested by the patient’s clinical manifestations—acute or subacute? Explain your answer. (50 words and one citation within the past four years)
2. Which three of the illnesses in this patient’s medical history may be contributing to the onset of infective endocarditis, and why are these diseases considered risk factors? Explain each of the factors. (50 words and one citation within the past four years).

Please answer the following questions:

1.  Explain the underlying pathophysiology associated with hypertensive conditions. What are the associated pathological complications? (50 words and one citation within the past four years).
2. Detail a common congenital defect associated with the cardiovascular system of a pediatric patient. (50 words and one citation within the past four years).
3. Explain the differences between irritable bowel syndrome and inflammatory bowel disease. (50 words and one citation within the past four years).
4. Gastric cancers require meticulous management. Choose a gastrointestinal cancer that is primary-sourced in an organ of the gastrointestinal system and discuss the epidemiological characteristics and pathological ramifications of the condition. (50 words and one citation within the past four years).
5. Explain the differences between irritable bowel syndrome and inflammatory bowel disease. (50 words and one citation within the past four years).
6. Gastric cancers require meticulous management. Choose a gastrointestinal cancer that is primary-sourced in an organ of the gastrointestinal system and discuss the epidemiological characteristics and pathological ramifications of the condition. (50 words and one citation within the past four years).

Answer all of the questions below.

Scenario

A.O. is a 28-year-old woman who presents to your clinic with complaints of rectal bleeding and weakness. Five days ago, she noticed bright red blood in her stools. Furthermore, she reports that her daily bowel movements have increased to five or six with significant diarrhea. She has been weak for approximately 3 days. She has not traveled outside of the city, been hospitalized, or received antibiotics recently.

A proctosigmoidoscopy was conducted 3 days after the patient’s discharge from the acute care clinic. A significant pseudopolyps formation could be seen. Biopsies of the colon revealed erosions of the mucosa and ulcerations into the submucosa with mixed acute (i.e., neutrophils) and chronic (lymphocytes and macrophages) inflammatory cells. No dysplastic cells suggesting the development of colon carcinoma were seen. No multinucleated giant cells suggesting Crohn’s disease were seen. Inflammation and ulceration were limited to the rectum and sigmoid colon only. Crypts of Lieberkühn were intensely inflamed. Marked hemorrhaging of capillaries in the mucosa was also observed.

 Laboratory Blood Test Results

• Na+ = 143 meq/L
• BUN = 20 mg/dL
• Plt = 315,000/mm3
• AST = 33 IU/L
• K+ = 3.2 meq/L
• Cr = 1.1 mg/dL
• PO4-3 = 4.0 mg/dL
• ESR = 24 mm/hr
• ALT = 41 IU/L
• Cl- = 108 meq/L
• Hb = 10.8 g/dL
• CRP = 1.5 mg/dL
• T bilirubin = 0.9 mg/dL
• Alb = 3.1 g/dL
• HCO+3 = 18 meq/L
• Hct = 36%
• Ca+2 = 8.9 mg/dL
• PT = 11.3 sec
• Glu, fasting = 132 mg/dL
• WBC = 9,400/mm3

Questions

1. What is the relevance of the last sentence in the first paragraph of the scenario provided above: “She has not traveled outside of the city, been hospitalized, or received antibiotics recently”? Explain your answer in detail. (50 words and one citation within the past four years).
2. What is the diagnosis? Explain your answer. Why and how did you come up with this diagnosis? (50 words and one citation within the past four years).
3. Identify eight abnormal laboratory blood test values and provide a brief pathophysiological explanation for each of them. (50 words and one citation within the past four years).

Please answer the following questions:

1. Explain the differences between restrictive and obstructive respiratory disorders. Choose one disorder for each and explain the pathophysiological changes seen and alterations in pulmonary function tests that aid diagnosis. (50 words and one citation within the past four years).
2. Explain the manifestations of congenital pulmonary disorders seen in children. (50 words and one citation within the past four years).
3. Discuss the differences between respiratory acidosis and respiratory alkalosis. Provide a case study or presentation associated with respiratory acidosis or respiratory alkalosis. (50 words and one citation within the past four years).
4. Clinicians have developed an appreciation for obstructive sleep apnea. Explain the pathophysiological problems a patient could experience associated with obstructive sleep apnea (OSA). (50 words and one citation within the past four years).
5. Explain the concept of azotemia (including prerenal, renal, and postrenal), causes, and diagnostic measures used to identify each. (50 words and one citation within the past four years).
6. Identify and discuss the pathophysiology underlying one pediatric urological disorder. (50 words and one citation within the past four years).
7. A patient presents with flank pain. You suspect renal calculi. What is the pathophysiological reason for development of renal calculi and associated treatment considerations to rid renal stones and prevent future development of others? (50 words and one citation within the past four years).
8. Explain the common conditions associated with proteinuria and hematuria. Discuss the rationale for potential complications. (50 words and one citation within the past four years).
   

   Assignment: Advanced physiology and pathophysiology Sample

   Scenario 1

   1. Type of infective endocarditis suggested by patients clinical manifestation

   The probability of acute infective endocarditis is raised by the patient’s clinical symptoms, which include an elevated temperature, shivers, and the presence of painful bumps on the fingers and toes. Rapid onset of such severe symptomsare indicative of acute infective endocarditis (Bonaros et al., 2020).

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   2. Three of the illness in the patients medical history

   The three conditions in the medical background of a patient that may influence infective endocarditis are mitral valve replacement, rheumatic fever, and alcoholic liver diseases. Because heart valve dysfunctional can easily result to infection, rheumatic fever is considered a risk possibility (Wu et al., 2020). Also, replacing the mitral valve raises the risk of endocarditis because the prosthetic valve contains foreign material that could function as a location for the attachment of bacteria.

   1. Underlying pathophysiology linked with hypertensive and associated complications

   Hypertensive circumstances cause systemic blood pressure to rise, which can result in several pathophysiological alterations. Endothelial dysfunction from chronic hypertension can result in atherosclerosis and blood vessel narrowing. It may also enlarge the heart, raising the chances of cardiac failure (Yu et al., 2021).

   2. Common congenital defects associated with cardiovascular systems of a pediatric patient

   A typical congenital condition affecting the circulatory system in young individuals is Ventricular septal defect (VSD). Blood can move from left to right ventricles via an irregular hole. Hence, a vertical and horizontal shift can lead to pulmonary hypertension, right-sided cardiac failure, and increased blood volume in the pulmonary circulation (Crawford, 2020).

   3. Differences between irritable bowel syndrome and inflammatory bowel disease.

   The irritable bowel syndrome (IBS) is a functional condition without apparent structural or biochemical abnormalities marked by bloating, changed bowel habits, or abdominal pain (Colombel et al., 2019). The gut mucosa is not inflamed. On the other hand, IBD describes chronic inflammatory gastrointestinal problems likeCrohn’s disease and ulcerative colitis. IBD is characterized by immune-mediated inflammation, causing mucosal damage and ulcers.

   4. Gastrointestinal cancer that is primary-sourced in an organ of the gastrointestinal system and the epidemiological characteristics and pathological ramifications of the condition.

   The gastrointestinal cancer that primarily develops in the pancreas is the pancreatic cancer. Its epidemiology, makes it the fourth most cancer-related fatalities worldwide. Age, smoking, obesity, and particular genetic disorders are risk factors. Aggressive growth, local invasion, and early metastasis are pathological hallmarks (Rawla et al., 2019).

   References

   Bonaros, N., Czerny, M., Pfausler, B., Müller, S., Bartel, T., Thielmann, M., … &Ruttmann-Ulmer, E. (2020). Infective endocarditis and neurologic events: indications and timing for surgical interventions. European Heart Journal Supplements, 22(Supplement_M), M19-M25. https://doi.org/10.1093/eurheartj/suaa167

   Colombel, J. F., Shin, A., & Gibson, P. R. (2019). AGA clinical practice update on functional gastrointestinal symptoms in patients with inflammatory bowel disease: expert review. Clinical Gastroenterology and Hepatology, 17(3), 380-390. https://doi.org/10.1016/j.cgh.2018.08.001

   Crawford, D. (2020). Biological basis of child health 3: development of the cardiovascular system and congenital heart defects. Nursing Children and Young People, 32(4).https://doi.org/10.7748/ncyp.2020.e1245

   Rawla, P., Sunkara, T., &Gaduputi, V. (2019). Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World journal of oncology, 10(1), 10-27. https://doi.org/10.14740/wjon1166

   Wu, Z., Chen, Y., Xiao, T., Niu, T., Shi, Q., & Xiao, Y. (2020). Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016. BMC infectious diseases, 20(1), 1-10.

   Yu, B., Chen, H., Guo, X. Q., Hua, H., Guan, Y., Cui, F., … & Ma, H. J. (2021). CIHH protects the heart against left ventricular remodelling and myocardial fibrosis by balancing the renin-angiotensin system in SHR. Life Sciences, 278, 119540.https://doi.org/10.1016/j.lfs.2021.119540

   Scenario 2

   1. Relevance of the last sentence in the first paragraph of the scenario

   It is important to note that “the patient has not recently gotten antibiotics, been hospitalized, or gone outside of the city” because doing so helps rule out specific potential reasons for the patient’s symptoms (Dien Bard & Alby, 2018). Individuals may be infected while travelling andhospitalization can predispose one to infections.

   2. Diagnosis and how I came up with this diagnosis

   The diagnosis of inflammatory bowel disease (IBD) which is indicated by rectal bleeding, diarrhea, and inflammation restricted to the sigmoid and rectum colonis ulcerative colitis(Gajendran et al., 2019). On biopsy, ulcerative colitis is identified by pseudopolyps, erosions, and ulcerations. The absence of dysplastic cells rules out colon cancer, and the absence of large multinucleated cells rules out Crohn’s disease.

   3. Abnormal Laboratory Blood Test and Pathophysiological Explanation.

   Hemoglobin level of 10.8 g/dL suggests anaemia (Zhang et al., 2022),Hct = 36% Low hematocrit indicatesanaemia and confirms bleeding. Na+ = 143 meq/L, Elevated sodium levels could result from hemoconcentration from fluid loss.  K+ = 3.2 meq/L ,Diarrhea can lower potassium levels. Reduced bicarbonate levels are a sign of metabolic acidosis HCO+3 = 18 meq/L. f) BUN = 20 mg/dL ,Mild dehydration which may slightly result in high blood urea nitrogen levels.

   1. Differences Between Restrictive and Obstructive Respiratory Disorders .

   Pulmonary fibrosis illustrates a restrictive respiratory condition, which lowers lung compliance. As a result, lung volumes are reduced, and inspiration-related expansion is compromised (Tissot et al., 2020). Reduced forced vital capacity (FVC), and reduced volumes of the lungs are shown by pulmonary function testing. Asthma is an illustration of an obstructive respiratory condition. From pulmonary function tests, residual volume increased, expiratory rates of airflow are reduced, and the FEV1/FVC ratio is reduced.

   2. Manifestations of Congenital Pulmonary Disorders

   Children experiencing congenital pulmonary disorders may show in a variety of ways. Tracheoesophageal fistula, congenital cystic adenomatoid malformation, and diaphragmatic hernia are some examples. Respiratory distress, cyanosis, and irregular respiration sounds can result from these diseases (Bush et al., 2019).

   3. Diffrences between Respiratory acidosis and

   Respiratory acidosis results from an increase in levels of arterial carbon dioxide. In contrast, respiratory alkalosis is due to reduced levels of  arterial carbon dioxide. A case study associated with respiratory acidosis could involve a patient with chronic obstructive pulmonary disease (COPD) experiencing acute exacerbation and retaining carbon dioxide (Pahal& Sharma, 2019).

   4. Problems a Patient Could Experience Associated with Obstructive Sleep Apnea

   Airway constriction is caused by increased collapsibility of the upper airway and decreased tone of the dilator muscles. Hence, there is disturbed breathing, sporadic hypoxia, hypercapnia, and awakenings from sleep. OSA is linked to neurological problems, and cardiovascular issues (Iannella et al., 2020).

   5. Concept of Azotemia, causesand Diagnostic Measures Used to Identify Each

   Azotemia is the accumulation of nitrogenous waste products in the blood due to reduced kidney activity. Reduced renal perfusion leads to prerenal azotemia. Acute tubular necrosis is one example of an intrinsic kidney injury causing renal azotemia. The obstruction of the urinary tract results in postrenal azotemia. Diagnostic procedures include evaluating blood urea nitrogen, creatinine, urine, and imaging investigations (Tyagi &Aeddula, 2019).

   6. Pathophysiology Underlying One Pediatric Urological Disorder.

   Vesicoureteral reflux (VUR), in which urine runs backwards from the bladder to the ureters and the kidneys, illustrates a juvenile urological condition. VUR can cause renal damage, pyelonephritis, and urinary system infections. Renal imaging and voiding cystourethrography are used in the diagnosis. Surgery or antibiotic prophylaxis are possible forms of treatment (Secretariat, 2019).

   7. Reason for Development of Renal Calculi and

   Substances that precipitate and amass in the urinary tract can cause renal calculi. Supersaturation of urine with chemicals that cause stones, insufficient urine volume, and altered urine pH are all contributory factors. The stone’s size, location, and nature will determine the treatment method. Increasing hydration intake and changing your diet are prevention techniques (Cho et al., 2021).

   8. Conditions Associated with Proteinuria and Hematuria and the Rationale for Potential Complications

   Proteinuria describes the availability of too much protein in the urine. On the other hand, conditions likeglomerulonephritis, kidney stones, bladder tumors, and urinary tract infections, can cause Hematuria. These disorders might result from Complications such as renal impairment, chronic kidney disease, or urinary tract infections(Yap & Lau, 2023).

   References

   Bush, A., Chitty, L. Y. N., Harcourt, J., Hewitt, R. J., & Nicholson, A. G. (2019). Congenital lung disease. In Kendig’s disorders of the respiratory tract in children (pp. 289-337). Elsevier. https://doi.org/10.1016/B978-0-323-44887-1.00018-3

   Cho, A., Duffy, P. G., &Smeulders, N. (2021). Urinary Tract Calculi. In Essentials of Pediatric Urology (pp. 139-152). CRC Press.

   Dien Bard, J., & Alby, K. (2018). Point-counterpoint: meningitis/encephalitis syndromic testing in the clinical laboratory. Journal of Clinical Microbiology, 56(4), e00018-18. https://doi.org/10.1128/jcm.00018-18

   Gajendran, M., Loganathan, P., Jimenez, G., Catinella, A. P., Ng, N., Umapathy, C., … &Hashash, J. G. (2019). A comprehensive review and update on ulcerative colitis. Disease-a-month, 65(12), 100851. https://doi.org/10.1016/j.disamonth.2019.02.004

   Iannella, G., Maniaci, A., Magliulo, G., Cocuzza, S., La Mantia, I., Cammaroto, G., … &Vicini, C. (2020). Current challenges in the diagnosis and treatment of obstructive sleep apnea syndrome in the elderly. Pol Arch Intern Med, 130(7-8), 649-654.

   Pahal, P., & Sharma, S. (2019). Chronic obstructive pulmonary disease (COPD) compensatory measure. StatPearls [Internet].

   Tissot, C., Phelps, C. M., da Cruz, E. M., & Miyamoto, S. D. (2020). Pericardial diseases. Critical Care of Children with Heart Disease: Basic Medical and Surgical Concepts, 503-522.

   Tyagi, A., &Aeddula, N. R. (2019). Azotemia.

   Yap, H. K., & Lau, P. Y. W. (2023). Hematuria and proteinuria. In Pediatric kidney disease (pp. 373-404). Cham: Springer International Publishing.

   Zhang, S., Shu, Y., Chen, Y., Liu, X., Liu, Y., Cheng, Y., … & Liu, M. (2022). Low hemoglobin is associated with worse outcomes via larger hematoma volume in intracerebral hemorrhage due to systemic disease. MedComm, 3(1), e96. https://doi.org/10.1002/mco2.9