Health care case Study
Case Study: Acute Renal Injury and Chronic Kidney Disease
- What is the difference between azotemia and uremia?
Both uremia and azotemia means that a person’s kidney is not functioning normally. The levels of creatinine and urea in the blood are crucial in indicating the deteriorating function of the kidney. Uremia means having urine in the blood. One among the major functions of the kidney is excreting nitrogenous waste resulting from metabolism of proteins and amino acids. In the normal conditions, uric acid and urea formed after breakdown of protein is filtered via the kidney and excreted in the urine (Bellomo, Kellum & Ronco, 2012). However, with the kidney functioning affected by local or systemic infection in the body, urea is found in the blood. This is reported in the last stage of kidney failure or acute kidney failure when there is total shutdown of the kidney function. Azotemia, on the other hand, is nitrogen in the blood. It is considered as the chemical stage of kidney failure in that the patient does not show overt signs of kidney disease (Huang, et al., 2018).
- Two years ago, Will’s physician told him to decrease his protein intake. In spite of what the physician ordered, Will could not stop having chicken, beef, pork, or eggs at least once a day. Why did his physician warn him about his diet?
In times of renal sufficiency, a patient’s kidneys have issues secreting waste products after protein metabolism. This means that the kidneys are not functioning normally and thus are unable to excrete the wastes after feeding on proteins. As a result, having a diet with a lot of protein would be a threat to the kidneys. Patients like Will are advised to take diets without or with low amounts of proteins to slow the progression of renal failure condition as well as decreasing the uremia symptoms. However, having Will take chicken, beef, pork, or eggs at least once a day was not a threat to his health condition. This is because these proteins are high biologic proteins implying that they are used by the body efficiently with less nitrogenous waste (Lameire, et al., 2013).
- Will’s feelings of weakness and fatigue are symptoms of anemia. Why is he anemic?
In renal failure, as is the case for Will, erythropoietin secretion decreases and this a condition that increases that patient’s feeling of weakness. In addition, production of red blood cells goes below the amount required in the body. With low amounts of red blood cells, a patient would be anemic and thus fatigued. Further, RBC lifespan is shortened as a result of accumulation of nitrogenous waste. Since the levels of length of time for RBC are determining factor in a patient’s anemic state, when they are shortened, one would feel weak and tired easily. Lastly, with Will’s anorexia being significant, deficiency of dietary iron is a factor in development of the anemic state. Having deficiencies of iron combined with low production of red blood cells as well as shortened life of RBC, the patient will be anemic and thus feel weak and fatigued (Chawla, Eggers, Star & Kimmel, 2014).
- Knowing what you do about Will’s history, why is left ventricular dysfunction a concern for his physician?
Left ventricular dysfunction is a concern for the physician because of the patient’s health history of hypertension. According to Chawla and Kimmel (2012), hypertension leads to increased workload on the left ventricle while increasing demand for oxygen. Further, since Will is still anemic and thus is weak and fatigued, anemia is a condition that contributes to ischemic events and left ventricular hypertrophy. This means that dysfunction of the left ventricular is a great threat to Will’s health condition. Additionally, based on the patient’s health history, left ventricular dysfunction is likelihood and thus should be prevented or managed immediately it occurs. This is because the patient has extracellular fluid overload that threatens left ventricular dysfunction as well as congestive heart failure.
Case Study: Disorders of Hepatobiliary and Exocrine Pancreas Function
- Anemia and clotting disorders are common features of alcoholic liver disease. What are the mechanisms that cause these hematological disorders?
Anemia and clotting disorders are common signs of liver disease. It is also possible for them to result from an impaired liver. For the case of alcoholic liver disease, alcohol enhances the demand for folic acid that is required for production of red blood cells thus leading to anemia. Instead of folic acid being used for the right purposes of increasing production of red blood cells to reach the right quantities for the body, alcohol uses the folic acid that could be used for RBC production. In addition, alcohol impairs the ability of the body to clot since it thins blood implying that if a person an alcoholic is injured, he would lose a lot of blood as it would not clot easily (Lankisch, 2009).
- What gastrointestinal bleed is associated with a high mortality rate in those with advanced cirrhosis? What is the pathophysiology of this condition?
The gastrointestinal bleed linked to high mortality rate for cirrhosis cases is variceal hemorrhage. In cases of portal hypertension, the liver is impaired while the portal vein ha increased blood pressure. As a result, the variceal wall tenses thus weakening the vessel. With increased blood pressure and thickening of the factors of the vessel, the resulting opening leads to variceal hemorrhage (Gavaghan, 2002).
- Acute pancreatitis is sometimes seen in the alcoholics, particularly after binge drinking. Why are tachycardia and hypotension indications of this condition?
Hypotension and tachycardia are indications of acute pancreatitis. This is as a result of alcoholism since as noted by Tran, Van Lanschot, Bruno and Van Eijck (2010), alcohol thins blood as well as suppressing the respiratory system. This way, the heart is forced to compensate by raising blood pressure and increasing contradictions.
- Why are women more predisposed to alcoholic liver disease than men?
Even though the alcohol is metabolized at the same rate by the liver for both men and women, the challenge is the amount of water held in the bodies. For men, the amount of water in the body is 65% while for women it is 55%. According to Tran, Van Lanschot, Bruno and Van Eijck (2010), alcohol is absorbed in the blood before it is carried to cells in water. Since women have less amounts of body water compared to men, they are more likely to end up with higher blood concentrations of alcohol even after taking the same amount of alcohol as men. It is clear that the liver of females is not more sensitive than that of men. However, the concentration of alcohol reaching a female’s liver is much higher and this is the reason the liver is at a greater risk of being damaged faster. This is the reason the recommended drinks per week for women is less than that of men.
Bellomo, R., Kellum, J. A., & Ronco, C. (2012). Acute kidney injury. The Lancet, 380(9843), 756-766.
Chawla, L. S., & Kimmel, P. L. (2012). Acute kidney injury and chronic kidney disease: An integrated clinical syndrome. Kidney International, 82(5), 516-524.
Chawla, L. S., Eggers, P. W., Star, R. A., & Kimmel, P. L. (2014). Acute kidney injury and chronic kidney disease as interconnected syndromes. The New England Journal of Medicine, 371(1), 58-66.
Gavaghan, M. (2002). The pancreas: Hermit of the abdomen. AORN Journal, 75(6), 1110-1135.
Huang, S-T., et al. (2018). Renal complications and subsequent mortality in acute critically ill patients without pre-existing renal disease. Canadian Medical Association Journal, 190(36), 1070-1080.
Lameire, N. H., et al. (2013). Acute kidney injury: An increasing global concern. The Lancet, 382(9887), 170-179.
Lankisch, P. G. (2009). Secretion and absorption (methods and functions). Best Practice & Research Clinical Gastroenterology, 23, 325-335.
Tran, T. C. K., Van Lanschot, J. J. B., Bruno, M. J., & Van Eijck, C. H. J. (2010). Functional changes after pancreatoduodenectomy: Diagnosis and treatment. Pancreatology, 9(6), 729-737.