Discussion 3 Respond Patho

Discussion 1 Luna

Urinary and Reproduction Function

Urinary Function

Question I

Analyzing the case presented names of the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney Injury.

Mr. J.R. could be suffering from prerenal acute kidney injury. The condition is associated with dehydration that impairs kidney perfusion. The patient’s dehydration resulted from persistent diarrhea and vomiting which are associated with massive fluid loss from the body (Walley et al., 2019). Low fluid volume impaired kidney perfusion resulting in cellular damage. The impaired perfusion affects the brain as well, causing reduced cerebration. Low brain activity causes orthostatic hypotension, whose presentation includes dizziness when standing up, as Mr. J.R. is experiencing.

Mr. J.R. presents intrinsic acute kidney injury symptoms as well. This kind of presentation includes fever, vomiting, and confusion. The condition results from acute interstitial nephritis caused by reactions to certain drugs. Bismuth sub-salicylate, which the patient ingested, contains salicylic acid that may cause such reactions (Mercado et al., 2019). Therefore, an intrinsic acute kidney injury diagnosis is probable given the patient’s fever, vomiting, and use of Pepto-Bismol drugs.

Question II

Create a list of risk factors the patient might have and explain why.

1. Dehydration

Dehydration causes multiple physiological changes that increase a patient’s susceptibility to AKI and one of them is hypotension. The condition reduces the amount of fluid available for circulation, impairing oxygen-carrying capacity in the blood. Low perfusion implies lower rates of oxygen transport to organs including the kidneys. Persistent hypoperfusion prolongs cellular hypoxia and cell death. Cellular degeneration in the kidneys comprises AKI. Therefore, dehydration’s fluid loss increases a patient’s propensity of developing acute kidney injury (Divney et al., 2019).

2. Hypertension

Several factors result in hypertension in populations of all ages. However, the condition has the highest prevalence of up to 72% in geriatric populations, making it probable comorbidity for Mr. J.R (Divney et al., 2019). The condition results from increased cardiac output or altered peripheral resistance and causes extreme blood pressure in vessels. Major vessels’ endothelium is thick enough to sustain this high pressure but tiny blood capillaries’ walls fail to withstand this change resulting in their damage. The impaired microcirculation interrupts free and hemoglobin-facilitated oxygen diffusion between blood and intracellular space, causing cellular hypoxia and eventual cellular death. Cellular death in kidneys constitutes AKI.

3. Cardiovascular disease

Heart disease increases the risk of acute kidney injury as well. The condition is popular across populations because 1 in 4 deaths have cardiovascular etiology. Geriatric populations are the most affected since age-related degeneration increases the risk of cardiovascular complications tenfold (Divney et al., 2019). This prevalence makes the condition possible comorbidity for Mr. J.R. Cardiovascular disease increases the risk of AKI due to its association with hypotension and hypertension. Each condition causes cellular hypoxia in the kidneys which results in injury.

Question III

Describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.

Chronic kidney disease (CKD) impairs multiple physiological mechanisms resulting in complications such as anemia. CKD causes anemia by hindering the production of red blood cells. Red blood cell production is triggered by erythropoietin, which is secreted by the peritubular cells of the kidney and the liver (Lv & Zhang, 2019). This hormone alters the chemical properties of erythrocytes to protect them against destruction and stimulates the stem cells of the bone marrow to produce more. CKD impairs the kidney’s capacity to produce erythropoietin. The amount of erythropoietin secreted by the liver is insufficient to sustain a healthy red blood cell production chain (Lv & Zhang, 2019). A low concentration of the hormone causes a higher red blood cell destruction rate and a lower production rate. This state results in anemia.

Case 2: Reproductive Function

Question I

According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probable diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.

Ms. P.C’s presentations and microscopic examination of the discharge support a pre-emptive diagnosis of gonorrhea. The presence of gram-negative intracellular diplococci in vaginal discharge is a major indicator of the condition (Zhang et al., 2021). Chlamydia produces similar results but the absence of hemorrhage as a symptom disqualifies it as a probable diagnosis. The physical appearance of the discharge rules out several differential diagnoses like bacterial vaginosis. Bacterial vaginosis causes a thick and dull gray vaginal discharge while the patient describes a thick discharge (Zhang et al., 2021). Similarly, the presence of symptoms disqualifies some asymptomatic conditions such as vaginal candidiasis, trichomoniasis, and human papillomavirus, which exist without triggering clinical presentations (Zhang et al., 2021). These indications help to narrow down the infection.

Question II

Based on the vaginal discharge described and the microscopic examination of the sample could you suggest which would be the microorganism involved?

The probable cause of the patient’s condition is Neisseria gonorrhoeae. This organism’s pathogenesis results in vaginal discharge bearing the characteristics of the patient’s specimen. The bacteria cause urethritis by invading the urethral epithelial cells in a polar fashion at the epithelial luminal surface. The interaction involves membrane fusion between the bacteria within the cell vacuoles. Frequent rupture of these vacuoles releases compounds that accumulate to form the discharge presented by the patient. In addition, the presence of white blood cells in the discharge is characteristic of this bacteria’s pathogenesis. White blood cells evidence the body’s inflammatory response against an exogenic organism. These observations and the clinical presentations make the Neisseria gonorrhoeae the most probable causative agent (Zhang et al., 2021).

Question III

Name the criteria you would use to recommend hospitalization for this patient

The patient’s presentations require urgent intervention and close observation to prevent complications. One of the criteria applicable for hospitalization is prolonged fluid loss. The patient has experienced vomiting for the last 48 hours. Vomiting is associated with high volume loss that can exceed the rate of intake. This process also leads to the loss of electrolytes from the body. Continuous loss over 48 hours can cause fluid and electrolyte imbalance, increasing a patient’s risk of developing hypotension, sepsis, and acute kidney injury. The state necessitates admission for the administration of fluid therapy and monitoring for further complications (Walley et al., 2019).

Another reason for hospitalization is the aggressive clinical presentation of the patient’s condition. Ms. P.C. experienced intense symptoms for two days, indicating advanced pathogenic growth or the existence of several conditions. A microscopic examination of the vaginal discharge specimen revealed the existence of yeast and diplococci, suggesting a fungal and bacterial condition. Hospitalization is necessary to allow enough time for exhaustive diagnostic testing. In addition, admission will provide enough time to monitor patient outcomes with a specific treatment plan. Advanced disease stages produce unpredictable results with conventional therapies, especially in comorbidities (Diehl-Schmid et al., 2017). Admission is necessary to monitor outcomes, vary interventions based on patient progress, and prevent complications.

In addition, Ms. P.C. may require hospitalization due to the absence of a primary caregiver at home given her partner is away on business. The patient is experiencing severe physiological distress characterized by nausea, vomiting, and abdominal pain. Moreover, the two days of illness have caused body weakness and reduced her ability to care for herself. So, the patient’s welfare may deteriorate while at home alone. Hospital admissions will care for the patient until she regains her health or a primary care provider is available. This admission will contribute to better patient outcomes (Walley et al., 2019).

 

References

Diehl-Schmid, J., Richard-Devantoy, S., Grimmer, T., Förstl, H., & Jox, R. (2017). Behavioral variant frontotemporal dementia: advanced disease stages and death. A step to palliative care. International Journal of Geriatric Psychiatry, 32(8). https://doi.org/10.1002/gps.4540

Divney, A. A., Echeverria, S. E., Thorpe, L. E., Trinh-Shevrin, C., & Islam, N. S. (2019). Hypertension Prevalence Jointly Influenced by Acculturation and Gender in US Immigrant Groups. American Journal of Hypertension, 32(1). https://doi.org/10.1093/ajh/hpy130

Lv, J. C., & Zhang, L. X. (2019). Prevalence and Disease Burden of Chronic Kidney Disease. In Advances in Experimental Medicine and Biology (Vol. 1165). https://doi.org/10.1007/978-981-13-8871-2_1

Mercado, M. G., Smith, D. K., & Guard, E. L. (2019). Acute kidney injury: Diagnosis and management. American Family Physician, 100(11).

Walley, A. Y., Wakeman, S. E., & Eng, G. (2019). Case 6-2019: A 29-Year-Old Woman with Nausea, Vomiting, and Diarrhea. New England Journal of Medicine, 380(8). https://doi.org/10.1056/nejmcpc1816407

Zhang, J., Li, J., & Yan, J. (2021). Introduction of Female Reproductive Processes and Reproductive Diseases. In Advances in Experimental Medicine and Biology (Vol. 1300). https://doi.org/10.1007/978-981-33-4187-6_2

Discussion 2 Davis

Case Study 1: Urinary Function

1. The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.

Acute Kidney Injury (AKI) is a condition characterized by the sudden impairment in the functioning of the kidney (Kellum et al., 2021). The kidneys fail to filter wastes from the bloodstream leading to accumulation of the unfiltered wastes, mainly nitrogen wastes, to alarming levels. There are three types of AKI, namely, intrinsic, post-renal, and prerenal. From the clinical manifestations presented by Mr. J.R, it is evident that he is suffering from AKI. The exact type of AKI that Mr. J.R could be suffering from is the prerenal AKI based on his clinical manifestations, like dizziness, vomiting, diarrhea, nausea, the bothersome metallic taste in the mouth, and fever. Prerenal AKI occurs when blood flow to the kidney is reduced, exhibited by dehydration and dizziness as major symptoms. Intrinsic AKI occurs when there is direct damage to the kidney due to infections, sepsis, or diseases. The symptom of intrinsic AKI presented by Mr. J.R is nausea. Post-renal AKI occurs when an obstruction occurs in the urinary tract just beneath the kidneys leading to a build-up of kidney waste. Symptoms like fever characterize post-renal AKI.

2. Create a list of risk factors the patient might have and explain why.

The risk factors that might predispose Mr. J.R to AKI include the following:

1) Age- Mr. J.R is 73 years old. He falls in the advanced age category and hence has an increased risk of developing AKI, among other conditions. 2) Past Medical History- The patient might have a history of congestive heart failure, which predisposes him to acute kidney failure. Additionally, Mr. J.R could have a past medical history of hypertension due to his advanced age. The incidence and prevalence rates of hypertension are high in advanced ages, hence the likelihood of Mr. J.R having hypertension. Hypertension is another condition that increases an individual’s risk of developing AKI. 3) Diabetes- since the patient’s family history is not given, he could be a type 1 diabetic patient or even type 2 diabetes mellitus due to his advanced age. The risk of Mr. J.R developing AKI could increase if he were a diabetic patient. 4) Being hospitalized for a serious condition- Mr. J.R is hospitalized with gastroenteritis, a serious infection that needs intensive care. The hospitalization due to gastroenteritis increases his chances of developing AKI. 5) Blood or fluid loss- The patient is pale, showing blood loss. Also, he had 5-6 watery bowel movements that led to fluid loss. Both fluid and blood loss are evident in the patient, increasing his chances of developing AKI.

3. Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.

A complication of the hematologic system that might arise from the diagnosis of chronic kidney disease is anemia (Jabbari & Vaziri, 2018). Another possible condition that could result from chronic kidney failure is hyperkalemia, which develops as a result of the inability of the kidney to filter potassium from the bloodstream. During chronic kidney failure, the kidneys cannot produce sufficient erythropoietin, making the body produce fewer red blood cells. When the red blood cells are inadequate, the amount of oxygen produced is also less, which impairs the normal functioning of body cells and organs. The inability of the kidney to make sufficient erythropoietin also increases an individual’s risk of developing anemia, which will also deprive tissues and organs of oxygen (Jabbari & Vaziri, 2018).

Case Study 2: Reproductive Function

1. According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probably diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.

Ms. P.C presented with lower abdominal pain, nausea, and a heavy malodorous vaginal discharge as the key complaints. Based on her presentation of the clinical manifestations and the microscopic examination of the vaginal discharge, Ms. P.C could be ailing from several sexually transmitted diseases (STDs) like pelvic inflammatory disease (PID), gonorrhea, and trichomoniasis. The gram stain tests done on the vaginal discharge indicate the presence of gonorrhea. The clinical manifestation of pain around the lower abdomen and the unusual vaginal discharge that can be yellow or green and smelly qualifies the diagnosis. However, the most probable diagnosis is trichomoniasis since the clinical manifestations, and microscopic examinations on the vaginal discharge support the diagnosis entirely. The key clinical presentation of trichomoniasis includes the abnormal vaginal discharge that is thick, greenish-yellow in color, and with a fishy smell (Rein, 2020). The vaginal discharge is also heavy, and in large quantities, which is the typical complaint of Ms. P.C. The other chief clinical manifestation of trichomoniasis is a pain in the lower abdomen, a symptom presented by Ms. P.C. The diagnosis for trichomoniasis is also qualified by the development of signs and symptoms between five (5) to twenty-eight (28) days after exposure, which falls within the range of the patient’s last unprotected vaginal sex (the last eight days). Trichomoniasis is also commonly passed through vaginal sex, unlike other STDs like gonorrhea, which can be transmitted through anal and mouth sex. The patient had started to have engaged in vaginal sex only, and therefore the probable diagnosis of trichomoniasis is qualified by this. Ms. P.C is also unsure about her sexual partner having a sexually transmitted infection. It could be so because trichomoniasis doesn’t present signs and symptoms in males; hence, the partner can only transmit the disease but rarely experience it.

2. Based on the vaginal discharged described and the microscopic examination of the sample could you suggest which would be the microorganism involved?

The vaginal discharge described and the microscopic examination done all suggest the presence of a bacterial microorganism since the microorganism is negative of yeast but gram-positive. Since the probable diagnosis is trichomoniasis, the most likely microorganism involved in the disease transmission is Trichomonas vaginalis. Trichomonas vaginalis is a single-celled parasitic protozoan flagellate transmits trichomoniasis disease through sexual intercourse and mainly vaginal sex.

3. Name the criteria you would use to recommend hospitalization for this patient

From the case study, it can be seen that the patient is sexually active but at a tender age (19 years). The clinical manifestations and the microscopic examination of the vaginal discharge indicate the presence of a sexually transmitted illness that could most likely be trichomoniasis. Antibiotic medications like tinidazole and metronidazole can be used to cure trichomoniasis. The doctor will administer the dosage of either tinidazole or metronidazole orally. Since most patients don’t tolerate oral medications, Ms. P.C could be hospitalized because of her young age and monitor her tolerance to the oral medications. Additionally, untreated trichomoniasis can increase the risks of developing other serious STDs like HIV/AIDs. The patient might require hospitalization to ensure that trichomoniasis is treated effectively and reduce further complications. There is also increased resistance to Trichomonas vaginalis to antibiotics. Therefore, the patient should be hospitalized to check for resistance so that other chemotherapeutic options can be employed in case of resistance (Küng et al., 2019).

 

 

References

Jabbari, B., & Vaziri, N. D. (2018). The nature, consequences, and management of neurological disorders in chronic kidney disease. Hemodialysis International, 22(2), 150-160. https://doi.org/10.1111/hdi.12587

Kellum, J. A., Romagnani, P., Ashuntantang, G., Ronco, C., Zarbock, A., & Anders, H. J. (2021). Acute kidney injury. Nature Reviews Disease Primers, 7(1), 1-17. https://doi.org/10.1038/s41572-021-00284-z

Küng, E., Fürnkranz, U., & Walochnik, J. (2019). Chemotherapeutic options for the treatment of human trichomoniasis. International Journal of Antimicrobial Agents, 53(2), 116-127. https://doi.org/10.1016/j.ijantimicag.2018.10.016

Rein, M. F. (2020). Trichomoniasis. In Hunter’s tropical medicine and emerging infectious diseases (pp. 731-733). Elsevier. https://doi.org/10.1016/B978-0-323-55512-8.00100-9

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