Diagnosing Conditions In Joshua And Alf: An Essay On Case Studies.

Joshua is a marine biologist who travels frequently to attend conferences. He has presented to his GP complaining of stabbing pain in the epigastrium and discomfort in his chest, which he says has been getting worse over the past three months. This discomfort increases after meals, especially if he eats fatty or spicy food that cause a burning sensation in the epigastric region which is relieved by further eating or a glass of milk, along with bloating and dyspepsia. Because of his frequent travelling, he admits that his eating habits are pretty irregular.

1) List all the signs and symptoms from the given case study. Identify which ones are signs and which ones are symptoms?

2) Outline three (3) possible conditions for Joshua, and provide the rationale for the conditions that you have chosen. These conditions will represent your differential diagnosis.

3) Briefly explain the haematology test results for Joshua.

4) Apart from the signs and symptoms presented in this case, name four (4) other clinical findings that may be discovered if a physical examination was conducted on Joshua?

5) Select two (2) further investigative tests that you would you like to order to help you arrive at a definitive diagnosis? Explain how these tests can help the diagnosis?

6) Select one of your differential diagnoses as the most likely reason for Joshua’s complaints. What are the conventional treatments used for this condition?

7) How could this condition be managed apart from the treatments?

Alf has a very poor diet. He consumes too much fat in his diet, and not enough fruits and vegetables. He admits that he isn’t much of a cook, and his

diet has worsened since his wife passed away, and he now has to cook for himself. He is very busy with volunteering for the Animal Welfare League,

and often eats on the run, grabbing the most convenient ‘fast-food’

1) Identify the signs and symptoms that Alf is presenting with.

2) From the information given in this scenario, propose three conditions that you would put forward as your differential diagnoses for Alf. What is the rationale for your choice?

3) Describe the pathophysiology underlying the mechanism of developing hypertension due to kidney disease.

4) What is the significance of high serum creatinine and urea levels in kidney diseases?

5) What three (3) investigative tests would you propose for Alf to establish a definitive diagnosis, giving your rationale for each?

6) Having investigated Alf’s case, what condition most likely explains Alf’s signs and symptoms?

7) Alf has asked for your advice. He wants to know the following:

What are the complications that may arise from this condition

What are the treatments for his condition?

What steps can he take to help manage his condition?

Symptoms include chest discomfort, stabbing pain in the epigastrium , burning sensation in epigastric region, nausea, recurrent flatulence, and dyspepsia. Signs, on the other hand, include bloating, belching, and disturbed sleep. 

Joshua’s haematology test indicates low haemoglobin and hematocrit, an indication that he may be anemic. Also, a  mean cell volume measurement above the normal range and normal cell haemoglobin  was shown, revealing that the anemic condition is macrocytic (Curry, 2015 ). The test results also indicated a high count of plateletes, above normal range. High platelet count is an indication that there is an infection, inflamation, bleeding, iron deficiency anaemia, or recent tissue damage (Association for Clinical Biochemistry & Laboratory Medicine, 2015). In this regard, Joshua is anaemic.

While haematology test results pinpoints at anaemia, while the signs and symptoms insinuates that Joshua may be suffering from peptic ulcers, which may be causing the anemic condition due to bleeding. A peptic ulcer is mostly associated with use of nonsteroidal anti-inflammatory drugs (NSAIDS or Helicobacter pylori (H. pylori). As Falcon, (2016) outlines, the most common associated symptom of peptic ulcers is stabbing pain or discomfort that worsens upon drinking alcohol, taking spicy foods or on an empty stomach. The associated pain with peptic ulcers occurs on and off and can be relieved by taking milk or antacids. Other signs and symptoms linked with peptic ulcers include bloating, belching, nausea, frequent hunger after eating (Falcon, 2016). Joshua is experiencing most of the mentioned signs and symptoms, and thus, may be affected by the condition. Specifically, Joshua may be suffering from duodenal ulcers since as mentioned by Simon, (2013), unlike gastric ulcers, duodenal ulcers can be relieved through further eating, as in Joshua’s scenario. Endoscopy results further backs a probability of Peptic ulcers.

Gastritis is another potential condition that may be affecting Joshua. Gastritis manifests as chronic inflammation of the lining of the stomach and is caused by Helicobacter pylori ( H. pylori) bacterium. Its associated symptoms include bloating, belching, abdominal discomfort, low count of red blood cells, and nausea (Davis, 2016). Additionally, individuals infected with this bacterium depict other symptoms such as burning sensation in epigastruc region, chest discomfort and dyspepsia. Foods rich in fats also may trigger symptoms associated with gastritis (Simon, 2013).

Joshua’s symptoms and signs may also be as a result of gastroesophageal reflux disease (GERD). GERD is characterized by smptoms such as burning sensation below the chest’s sternum especially after a meal, nausea, belching, and bloating (Falcon, 2016).  

A haematology test is arguably the most common blood test requested by healthcare professionals as it depicts the general health status of an individual (Medichecks, n.d). Overall, Joshua’s haematology results reveal anaemic condition evidenced by low haemoglobin and hematocrit count. Additionally, the above normal mean cell volume specifies that it is a macrocytic anaemia and the high platelet count above normal, an indication of an infection, bleeding, iron deficiency anaemia, inflamation, or recent tissue damage. For Joshua, it is most likely that the anaemic condition is caused by bleeding as a result of H. pylori infection causing inflammation and bleeding.

Question One

If a physicall examination was conducted on Joshua, the probable clinical findings that  may be discovered include Melena, as a result of gastrointestinal bleeding, epigastric tenderness (Anand, 2017),  enlargement of lymmalnutrph nodes resulting from infection, and malnutrition (Maakaron, 2016).

A biopsy and fecal occult blood test (FOBT) may be done as further investigative tests (WebMD, n.d ) The biopsy will help to test for H. pylori and determine whether it is the cause of infection while the FOBT will detect if the stool has blood, accounting for the anaemic condition being experienced by Joshua, and an indication of bleeding ulcers (WebMD, n.d ).

Joshua’s most probable complaints are as a result of peptic ulcers. The disease can be treated through convectional drug therapy with antacids, anticholinergic drugs, H2 receptor antagonists, and sucralfate If patients are users of nonsteroidal anti-inflammatory drugs (NSAIDS), treatment options include proton pump inhibitors (PPIs) and misoprostol (Fashner & Gitu, 2015).

PPIs block production of stomach acid and promote healing, sucralfate protect the stomach and small intestine lining, antacids neutralize stomach acid and relieve symptoms, and H2 receptor antagonists miminize acid production (Mayo Clinic Staff, 2016)           .

Peptic ulcers can be managed by reducing or seizing use of NSAIDS, where possible, and dietary manipulation (Lukie, 2009).

Alf’s signs include oedematous feet, face puffiness, swollen ankles, haematuria and high blood pressure. At the same time, the oedematous feet and swollen ankles may be classified as symptoms since they can be experienced by the patient.

Alf may be suffering from kidney disease, diabetes or hypertension. The  blood analysis results, urine examination results, and signs exhibited by Alf all points to kidney disease. The high serum creatinine and blood urea nitrogen (BUN) are an indication that the kidneys are not functioning properly or are impaired (Shiel, 2016, Knott, 2016). The results are further backed up by urine examination results which revealed blood in urine (haematuria), which is, in most cases linked to kidney disease. Oedematous legs, puffy face, and swollen ankles further points to kidney disease. Additionally, the test showed a fasting glucose level of 7.0, which indicates that Alf is diabetic. The diabetic condition is further indicatedby presence of glucose and proteins in the urine. Hypertension, on the other hand, is indicated by the high BP level, 180/115 as well as the presence of proteins in urine.

Bilateral chronic kidney disease results to increased plasma volume as well as cardiac output since it is characterized by retention of water and sodium (Monhart, 2013). Consequently, a dysbalance in vasoactive substances’effects accompanied with insufficient suppression of systems responsible of vasoconstriction and reduced vasodilatory agents production bring about hypertention (Monhart, 2013).  Similarly, hypertention can result from secondary hyperparathyroidsm which is characterized by elevated levels of intracellular calcium, which results to vasoconstriction and hypertension (Monhart, 2013). For unilateral kidney diseases, ischemia is the most common cause of hypertension which is due to formation of scarin inflammatory diseases or pressue of masses (Monhart, 2013).

Presence of high Creatinine and urea levels in the blood is a significant indicator in kidney diseases. As Shiel, (2016) states, creatinine is a reliable kidney function indicator where increased levels imply kidney disease or impaired fuctioning of kidneys. Impairement of kidneys leads to poor creatiine clearance by kidneys, accounting for the increased blood creatinine level (Shiel, 2016). Similarly, increased urea levels in the blood is an indication of kidney malfunctioning (Knott, 2016). High levels of urea in blood result from failure of the kidneys to appropriately filter urea (Gabbey, 2014). Thus, high urea and creatinine levels in blood is significant as it signhifies kidney problems.

Question Two

I would request a blood test, fasting blood glucose test, and blood pressure test. The blood test would help determine the waste product levels as well as electrolytes . Abnormal presence of any products that ought to be filtered by the kidney will confirm malfuctioning of kidneys. Fasting blood glucose test would determine the level of blood sugar and blood pressure test whether Alf has hypetension.

Alf’s signs and symptoms are best explained by kidney disease. The swollen ankles, oedematous legs, puffiness on the face, and hypertension are all associated symptoms and signs of kidney disease (Mayo Clinic Staff, 2016).

The complications that may arise from kidney disease include fluid retention which results to arm and leg swelling, pulmonary edema, and high blood pressure, cardiovascular disease, anemia, increased bone fracture risk, hyperkalemia, central nervous system damage pericarditis, and reduced immune response (Mayo Clinic Staff, 2016). Central nervous system damage may result to personality changes, loss of concentration, and suizures, while reduced response of immune system increases individual’s vulnerability to infections. On the other hand, hyperkalemia impairs the hearlt’s functioning ability (Mayo Clinic Staff, 2016).

It is not possible to cure chronic kidney disease, although treatment reduces its severity and relieves its symptoms (NHS, 2016). Treatment  options include kidney transplant especially if the disease is in its advanced stages, dialysis, medication, and lifestyle changes (NHS, 2016). Dialysis aims to replicate the functions supposed to be performed by the kidney and is necessary in advanced stages  while medications aim to manage and control the associated complications such as hypertension and high levels of cholestrol (NHS, 2016). Change in lifestyle aims to keep individuals healthy (NHS, 2016).

To manage his condition, Alf should take his prescribed medications as adviced by the physicians, develop a lifestyle that incorporates regular physical exercises, and eat a healthy and balanced diet. Regular physical excercises will help in maintaining health and fitness by preventing associated complications of kidney disease. Similarly, a diet rich in fruits and vegetables and dificient of fats and excess salts will help manage the high blood pressure (NHS, 2016).

References

Anand, B. (2017). Peptic Ulcer Disease Clinical Presentation . https://www.medicinenet.com/creatinine_blood_test/article.htm

Curry, C. V. (2015 ). Mean Corpuscular Volume (MCV) . Medscape . https://emedicine.medscape.com/article/2085770-overview

Davis, C. P. (2016). H. pylori (Heterobacter pylori Infection . https://emedicine.medscape.com/article/181753-clinical#b1

Falcon, D. (2016). Signs and symptoms of a Peptic Ulcer. https://emedicine.medscape.com/article/198475-clinical#b1

Gabbey, A. E. (2014). Blood Urea Nitrogen Test . https://www.healthline.com/health/blood-urea-nitrogen-test

Gitu, J. F., & c, A. (2015). Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection . American Academy of Family Physicians , 91(4): 236-242.

Knott, L. (2016). Routine Kidney Function Blood Test . https://emedicine.medscape.com/article/181753-clinical#b1

Lukie, B. E. (2009). Current Medical Management of Peptic Ulcer Disease. College of Family Physicians of Canada , 35: 2107-2110

Maakaron, J. E. (2016). Anemia Clinical Presentation . https://www.medicinenet.com/script/main/mobileart.asp?articlekey=388

Medichecks. (n.d). Haematology Profile . https://www.medichecks.com/haematology-blood-tests/haematology-profile

Medicine, A. f. (2015). Platelet Count. https://labtestsonline.org.uk/understanding/analytes/platelet/tab/test/

Monhart, V. (2013). Hypertension and Chronic Kidney Diseases . Czech Socirty of Cardiology , 55(4): 397-402.

NHS. (2016). Treatment for Chronic Kidney Disease. https://www.nhs.uk/Conditions/Kidney-disease-chronic/Pages/Treatment.aspx

Shiel, W. C. (2016). Creatinine Blood Test . https://www.medicinenet.com/creatinine_blood_test/article.htm

Simon, H. (2013). Peptic Ulcer . https://emedicine.medscape.com/article/2085770-overview

Mayo Clinic Staff. (2016). Peptic Ulcer. https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/treatment/txc-20231747

WebMD. (n.d ). Peptic Ulcer Disease- Exams and Tests . https://www.webmd.com/digestive-disorders/tc/peptic-ulcer-disease-exams-and-tests