Case Study Involving Pancreatitis For the last 12 hours Belinda has been having an abrupt onset of deep epigastric pain accompanied with nausea, vomiting, perfuse sweating, abdominal tenderness, and a fever of 102 F. Once admitted to the hospital the lab work reveals leukocytosis, elevated serum amylase, and elevated serum lipase, hypocalcemia, and elevated serum bilirubin. Belinda has proteinuria, glycosuria, hyperglycemia, and her serum ALT is 165. There is evidence from a CT scan that Belinda has been passing periodic gallstones and there is bile reflux in the pancreatic duct. She is very weak and she has a distended abdomen. 1. Considering Belinda’s diagnosis, what would be causing the inflammation occurring in her case? Would you classify this as an acute or chronic form of inflammation? Explain your answers. 2. What is responsible for causing the elevation of the pancreatic enzymes and hyperglycemia in this disease condition? 3. Why would Belinda be experiencing abdominal pain? Fever? Vomiting? Explain why each of the lab results be occurring in pancreatitis? 4. Looking at the vascular response that occurs in inflammation, what is the evidence that each step in that process is occurring? What is the evidence that the cellular response of inflammation is occurring in this case? 5. Would symptoms of jaundice be expected in Belinda’s case? Explain. If so, what would be the reason for Belinda to be jaundice? 6. (a) Explain the process that leads to fat necrosis. (b)Explain how Belinda’s current condition could progress to necrotizing pancreatitis? 7. If pancreatic abscess were to develop, how would Belinda’s condition change? What exudate would be found to confirm? What are the specific symptoms of this condition? How to Work a Case Study in Pathophysiology Part 1: The Patient A. If you have a patient to which you can ask questions: 1. First get a list of symptoms and their “history” as it relates to the current situation (this is not a “clinical” course and you’re not in a true clinical setting so for our purposes you will not need the full history of the patient). You can ask the patient their symptoms and they will tell you all they know. 2. To obtain a pt. history you will have to ask some specific questions; such as “have you had these symptoms long; when did they first begin; do you have a history of heart problems, or diabetes mellitus, or are you a smoker, etc. 3. Assume you can perform a physical exam (don’t actually do it!!) – the patient will provide the vital signs you ask for and any other pertinent information you may need 4. You can request lab tests – you request what you want done; if they are pertinent to the situation the patient will provide you with the results 5. Be certain to ask if they are on any medications (including vitamins and OTC [over the counter] meds. B. If you don’t have an actual patient present, all of the above information will be provided for you; however, it may be in an “interrupted” format – meaning you may have to answer some questions before more information will be provided. Whichever situation you have – you will have to provide a summary of what you “asked and learned” about the patient in a “report of information” format (a handout will be provided to direct you with this). Part 2: Analysis of Pathophysiology A. Discuss each disease process pathophysiology that you identified – if we have not covered the disease process in the course the description should be brief (1-2 sentences). But, if we have covered it the description should be detailed (1 – 2 paragraphs may be necessary). 1. For example, if in week 3 the case study has a patient with an injury due to radiation exposure (which is why they are being seen at the hospital), but also suffers from diabetes mellitus you should describe the pathophysiology and manifestations of the radiation injury in detail (since we would have covered it by then), but only a brief statement about diabetes mellitus as we won’t have covered it yet. 2. In these descriptions, every symptom and abnormal lab should be addressed. If the disease implications of an abnormal lab value are not known then give 1-2 plausible explanations (see “b” below) a. For a disease process: 1. give a description of the disease 2. general symptoms of this disease 3. how do you know this patient has it (what signs / symptoms do they have) 4. what additional manifestations could possibly occur b. If an abnormal lab has no specific disease associated with it: 1. There are quite a few lab results that have multiple indications and cannot be attributed to a single disease process a. For example: if a patient has low sodium (hyponatremia) numerous things can be the cause and there are multiple manifestations. Therefore, you should give some “possible” causes and manifestations that may link to the circumstances of your patient. In other words, what is currently going on with the patient that may cause hyponatremia, and which of their signs / symptoms could be attributed to it? 2. Occasionally you may also be asked to recommend a possible treatment for the patient An example of a case description and a description of a disease process: The Patient: A 25 year-old female comes to you with complaints of continuous fatigue, shortness of breath – especially after brief exertion, muscle weakness, frequent headaches, and a sense of a “rapid heart rate”. All of these have been going been going on for several months. The patient denies use of any medications (including vitamins and other OTC medications). Upon physical examination you notice that their skin is pale, she is very thin (ht. 65”; wt. 102 lbs.), her resting heart rate is 120 bpm, and a respiratory rate of 25 bpm. Upon palpitation the liver and spleen appear normal. A CBC is ordered with the following results: Hematocrit: 36.2%, Hemoglobin: 8.1 g per dL. After additional information from the patients history (too much to put in an “example”) you determine that the patient is suffering from anemia due to iron / vitamin deficiency. The Description of the disease process: The patient is most likely suffering from anemia due to insufficient iron and vitamins such as folate and B-12. Anemia is a not a specific disease but rather a condition which results from lack of healthy red blood cells which carry oxygen to the body tissues. The patient’s tachycardia is likely resulting from the heart’s attempt to increase blood delivery (and thereby oxygen delivery) to the body tissues. Likewise, the tachypnea (rapid breathing) is also due to the compensatory processes of the respiratory centers in the brain and the lungs to increase oxygen delivery to the blood.Her headaches, fatigue, and shortness of breath are all due to the lack of oxygen in the cells. This patient’s hematocrit is within the normal range indicating that her bone marrow is effectively producing red blood cells; however the low hemoglobin, which is the protein that carries the oxygen, indicates the possibility of a lack of sufficient nutrients to form the protein. One of the nutrients is iron, which is what binds to the oxygen in the hemoglobin molecule. Without adequate iron, your body can’t produce enough hemoglobin for red blood cells. This type of anemia is often caused by blood loss, such as from heavy menstrual bleeding, an ulcer, cancer, a polyp somewhere in your digestive system, and prolonged use of aspirin or drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs). (http://www.mayoclinic.com/health/anemia/DS00321). Other vitamins such as folate and B-12 are necessary for the formation of the components of RBCs. Although this patient’s hematocrit is in a normal range, it is at the low end and could indicate that her condition may be progressing. The patient has indicated that she eats poorly and does not supplement her diet with vitamins. Given her low weight, additional testing may be necessary to determine there are no additional problems occurring. Part 3: The Roles of the Participants in a Case Study All members of a group are responsible for providing their thoughts and analysis to the case and therefore will share equally in the grade. However, these role assignments will help ensure that all members are working together as a cohesive group. The number of “roles” in a particular case may vary, each case will list the required roles. The possibilities are listed below: 1. The Patient – in some cases a student will take on the role of the patient and will be provided with all the symptoms, signs, history, medications, test / lab results. The degree to which the student wishes to “act out the role” is entirely up to the individual. Note that even though you are the patient, once you have provided all necessary information and your group is ready to make decisions and compile the case you will take on the role of the 2nd analyst or the encourager/ motivator (see below) 2. Manager / Facilitator – this person manages the group, ensuring members are fulfilling their roles, tasks are being completed in a timely fashion, all members are participating in activities / tasks. The manager also reads all the instructions, information, and questions to the group. I will only answer questions from the manager (and the Patient – while they are in their role). 3. Recorder / Presenter – this person’s role is to log all important information, keeping detailed notes, and completing the case study to turn in. If necessary, this person will present their group’s results to the class. 4. Reflector / Analyst – this person’s role is to “comment” on the progress and direction of the group’s responses. They should be analyzing the information and also offering input on whether they think the group is proceeding in the correct direction. They are also responsible for providing comments on the group’s dynamics at the end of the case. 5. Technician / Equipment mgr. / Researcher – this person’s role is to gather all necessary materials provided in class, obtain additional resources, do additional research either in the textbook, in other books provided in class, or online. 6. Encourager / Motivator – this position is reserved only for the “patient” who is no longer acting in that role. They may function to motivate and encourage the group to complete the case. Part 4: Grading of Case Studies The specific number of points possible will vary depending upon the case. The key to earning all the points is in your group’s ability to do the following: • Provide detailed summaries in the “report of information” regarding the patient • The ability to “see the big picture” of what is going on with the patient • The thoroughness of the description of the disease process – not just describing the disease, but why you determined it was what was occurring in the patient • Note that you do not have to have all the correct answers to receive full points – but you must show depth of thought and analysis • In addition, each case will contain points from a peer evaluation (in which each member will grade themselves and their other group members
Purchase answer to see full attachment