Diabetes, Hepatitis B, Eczema, and Melanoma - Assignment Example

Case Studies” Case Study A Using your knowledge of normal physiology, explain how glucose and protein can be present in the urine. Ans. According to the process of formation of urine, the maximum concentration of glucose kidneys can filter is 180 mg/dl. A concentration greater than 180 will be passed out in the urine. The reason for glucose to be present in urine is gestational diabetes i.e. a concentration greater than 180 mg/dl (Metcalf, 2008). Also, the presence of proteins in the urine indicates damage to the renal tubules or UTI. 2. List the potential risks with gestational diabetes Ans. The major potential risks of gestational diabetes are: Over weight baby Increased risk of abortion/miscarriage Congenital Abnormalities because of affecting the baby in early pregnancy Hyperinsulinemia and high blood glucose levels of the infant. 3. Why was insulin prescribed? Ans. Insulin was prescribed because it is supposed to increase the uptake of glucose by the cells. Insulin does so by acting on the cell membranes and opening the glucose channels leading to increased uptake which is very necessary in cases of hyperglycemia (Metcalf, 2008). Also, insulin being indigenous to the body causes minimal side affects and is harmless to the infant 4. Suggest several possible complications of high blood pressure during pregnancy? Ans. During gestational hypertension, fetus is at main risk since the blood supply to the placenta can be considerably reduced leading to hypoperfusion of the fetus and may even cause intrauterine death (Catalano, 2000). 5. Why is close monitoring important during these pregnancies? Ans. Close monitoring of these cases is specially required throughout the duration of pregnancy since gestational diabetes and hypertension may lead to many congenital abnormalities, miscarriage and many other serious problems (Catalano, 2000). 6. Describe the pathophysiology of Type 2 diabetes. Ans. The main pathophysiology behind type two diabetes is the decreased or no secretion of insulin due to the destruction of beta cells of islets of langerhans in the pancreas or their absence congenitally. 7. Briefly describe how diet, exercise, and the drug each contribute to reduction of blood glucose. Ans. First of all a diet low in carbohydrates and rich in fats in proteins to fulfill body’s caloric needs would automatically decrease the blood glucose levels. Secondly exercise would increase the metabolism of the body leading to an increase in the glucose consumption and intake thus causing reduced blood glucose levels. Last of all drugs are supposed to act on the cell membranes and in the intestinal tract (Assche, 2004), they decrease blood glucose levels either by increasing its uptake by multiple folds or by decreasing its absorption from the intestinal tract. 8. Explain how stressors might affect blood glucose levels and blood pressure. Ans. Stressors increase the hormone levels of the body including insulin and might help in decreasing the blood glucose levels (American Diabetes association, 1952). 9. Why is persistent elevated blood pressure a serious concern in a patient? Ans. Persistent high blood pressure is a serious concern for the patient since it increase cardiac workload and may lead to cardiac hypertrophy as well as many other diseases such as MI or angina. It may also lead to the rupture of blood vessels in the brain and cardiac failure (Assche, 2004). 10. How does hypercalcemia cause renal calculi, and how do renal calculi cause severe pain? Ans. Hypercalcemia leads to the deposition of calcium salts in the renal system which coalesce to form renal calculi. These renal calculi when get big enough to cause the obstruction of the urinary duct cause severe pain. 11. How might reduced calcium intake affect C.S.? Ans. Reduced dietry calcium will reduce serum calcium levels and help in further formation of renal calculi. 12. Following a routine checkup and laboratory tests 2 years later, simvastatin (Zocor) was prescribed. Why is a cholesterol-lowering agent useful in the treatment of diabetes? Ans. Cholesterol lowering drugs would reduce the amounts of deposited cholesterol levels and provide energy to the body in the form of free fatty acids thus decreasing the dependency of the body on glucose only and providing an alternate source of energy (Metcalf, 2008). 13. A daily low dose of enteric-coated ASA was recommended. Why is this helpful in diabetics? Ans. Enteric coated ASA are helpful in avoiding many complications created by diabetes in diabetic patients which are the leading cause of death in these patients (Assche, 2004). 14. Explain why it is important to maintain low blood glucose levels. Ans. It is very important to maintain low blood glucose levels as severe hyperglycemia may lead to fainting and the patient may even pass into a state of coma and die (Assche, 2004). 15. Suggest several reasons why blood glucose levels may increase periodically. Ans. Bllod glucose levels may increase periodically mainly after meals as the diet contains carbohydrates. They may also increase when the body’s insulin secretions are very down due to the circadian rhythm of insulin secretion (Metcalf, 2008). References American Diabetes Association. (1952). Diabetes. New York: American Diabetes Association. Metcalf, T., & Metcalf, G. (2008). Diabetes. Detroit: Thomson/Gale. Weiss, P. A. M., & Coustan, D. R. (1988). Gestational diabetes. Wien: Springer-Verlag. Catalano, P. M., & Parker, J. K. (2000). Diabetes and pregnancy. Philadelphia, Pa: Lippincott Williams & Wilkins, Inc. Assche, F. A., & European Board and College of Obstetrics and Gynaecology. (2004).Diabetes and pregnancy. Amsterdam: Elsevier. Case Study B 1. Describe the pathophysiology of acute hepatitis B infection. Ans. The main reason behind the disease Hepatitis is the Hepatitis B virus. This virus enters the body through blood or the use of infected equipments etc. the virus after entering the body affects the liver mainly and leads to hepatitis and liver cirrhosis (Greshwin, 2007). 2. If J.B. had known about his exposure, could any treatment measures have been undertaken at the time? Ans. Yes if J.B had made proper arrangements to avoid exposure this disease could have been prevented or a proper anti viral treatment would have prevented the diseases from getting chronic. 3. Describe two signs of the preicteric stage and three signs of the icteric stage of acute hepatitis B infection. Ans. The preicteric phase mainly includes fever, anorexia and nausea while the icteric phase includes excessive itching, light colored feaces and dark urine (Bittar, 2004). 4. What serum markers remain high when chronic hepatitis B is present? Ans. The antibody to the capsular antigen of the hepatitis B virus is the main serum marker that remains high also the enzyme SGPT increased elevated during the infection (Greshwin, 2007). 5. Explain the circumstances under which J.B. could transmit the virus (including the various stages of the disease [preicteric, icteric, and so on] as well as the mode of transmission). Ans. J.B could transmit this virus if someone uses equipments used by J.B which have his blood stains on them or J.B’s blood is transfused to someone without screening (Bittar, 2004). 6. Explain how cirrhosis develops from chronic hepatitis B? Ans. Complicated hepatitis B infection carries on to affect the liver and the portal system. It causes further destruction of hepatic cells and leads to liver cirrhosis. 7. Explain why the early stage of cirrhosis is relatively asymptomatic? Ans. The early stages of liver cirrhosis are usually asymptomatic since the virus is usually in the incubation stage and some of the hepatic cells are in function fulfilling the metabolic requirements (Poynard, 2002). It does not produce symptoms until there is enough destruction of the hepatic cells to disrupt liver functions. 8. What factors predispose J.B. to each of the manifestations listed above? Ans. The main factor that predisposes J.B to the manifestations is the disruption in the normal physiology of liver which leads on to many other metabolic disorders causing the manifestations (Lee, 1999). Also, since most of the drugs and all the food materials have to pass through liver for metabolism, lack of metabolic needs causes malnutrition and worsening J.Bs condition. 9. If a cure for hepatitis B were discovered at this point, how would this affect J.B.’s prognosis? Ans. J.B has well passed the stage of treatment and even if a cure of Hepatitis is discovered now, it would not be of much help for him since his hepatitis has progressed to cirrhosis and anti viral treatment is not of much help in it (Freedman, 2009). 10. Explain why each of the following events occur: 1. excessive bleeding from trauma 2. Increased serum ammonia levels 3. hand-flipping tremors and confusion Ans. 1. Excessive bleeding from trauma occurred in his condition because of deficiency of normal metabolic processes. 2. Increased ammonia levels occurred due to decreased excretion of urea. 3. Tremors and confusion occurred as a neurological side effect of increased ammonia levels plus destruction of nerve cells due to malnutrition. References Freedman, J. (2009). Hepatitis B. New York: Rosen Pub. Lee, W. M. (1999). Hepatitis B. Philadelphia: W.B. Saunders. Poynard, T. (2002). Hepatitis B and C: Management and treatment. London: Martin Dunitz. Gershwin, M. E., Vierling, J. M., & Manns, M. P. (2007). Liver immunology: Principles and practice. Totowa, N.J: Humana Press. Bittar, E. E. (2004). The liver in biology and disease. Amsterdam: Elsevier JAI. Case Study C 1. State the factors in the family history that would support a genetic predisposition to atopic dermatitis in this infant. Ans. According to the family history, J.W is predisposed to atopic dermatitis if there is a variant gene for this disease in her family and it is transmitted as a recessive gene so if her mother had it she had 50 percent chances where as if her father had the disease there is a very much chance for her to get it (Westscott, 1997). 2. Explain why a secondary bacterial infection has probably developed. Ans. Atopic dermatitis or eczema just like any other skin disease provides a very suitable medium for bacterial growth and also, lack of immunity at that area aggravates their growth so there was a secondary bacterial infection at that site (Westscott, 1997). 3. List four factors that tend to aggravate atopic dermatitis Ans. The major factors that aggravate this condition are 1) moist conditions, 2) allergens, 3) Stress and 4) Certain foods such as milk and peanuts (Mitchell, 2006). 4. Explain two ways in which administration of an antihistamine could help J.W. sleep. Ans. Anti histamines are well known for their sedating effects so they would help J.B sleep (Rudikoff, 2003). 5. Explain how hydrocortisone cream would reduce the inflammation and skin damage. Ans. Hydrocortisone being a corticosteroid is a strong anti inflammatory plus it increases the rate of healing process hence helping J.Ws Condition (Ring, 2006). References Mitchell, T., & Hepplewhite, A. (2006). Eczema. London: Class Pub. Westcott, P. (1997). Eczema. London: Ward Lock. Top of Form Chu, T. (1998). Eczema. Oxford: Maxim MedicalBottom of Form Rudikoff, D. (2003). Eczema. New York: Elsevier. Ring, J., Przybilla, B., & Ruzicka, T. (2006). Handbook of atopic eczema. Berlin: Springer. Case Study D 1. Explain the factors that make this lesion suspicious for cancer Ans. Mr. PX had several moles on his skin which made him feel that this spot must also be a mole but moles are usually dark black and this spot was purplish red. Also the margins of this spot were very much irregular unlike that of a mole (Schofield, 2000). Most importantly the spot was thick and was raised above the skin which made this lesion suspicious of cancer. 2. List the possible predisposing factors in this patient. Ans. Mr. PX being a fair skinned person had less melanin pigment in his skin. Melanin is supposed to protect the skin against the harmful radiations i.e. UV from the sun and fair skinned people have less melanin so he was more prone to this disease. Also, fair skinned people are exposed to sun burns and freckles. Another risk factor in the development of malignant melanoma is a history of sun burns. Mr. PX has had many moles on the skin and having a large number of moles on the skin also predisposed him to the disease (Leong, 2003). Another important risk factor is living near the equator and over exposure to uv radiations. 3. Predict the prognosis and the reasons for it in this case. Ans. Although Mr. PX was prescribed to undergo a surgery for the removal of the cancerous lesions off his skin but as the history stated, the lesions had invaded the dermis and the local lymph nodes there was a very much chance of the lesion to spread to other parts of the body (Holman, 1982). Malignant lesions are very well known to spread other parts of the body i.e. metastasis. The main routes through which these cancerous cells metastasize are: blood and lymph nodes. The melanoma of Mr. PX had already invaded the lymph nodes so the prognosis was not so good and He must undergo extensive radiotherapy and chemotherapy to kill the remnants of the cancer in his skin and other parts of the body (Barnhill, 2003). References Leong, S. P. L. (2003). Malignant melanoma: Pt. 2. (Malignant melanoma.) Philadelphia, PA [etc.: Saunders. Holman, D. A. (1982). Risk factors in the causation of human malignant melanoma of the skin. Barnhill, R. L., Piepkorn, M., & Busam, K. J. (2003). Pathology of malignant melanoma. New York: Springer. Schofield, J. R., & Robinson, W. A. (2000). What you really need to know about moles and melanoma. Baltimore: Johns Hopkins University Press. Read More