Case Study Report on the Diagnosis and Treatment of a GI Condition

Establishing the Diagnosis

1. Apply knowledge of anatomy, physiology and pathophysiology to recognise how conditions manifest themselves.
2. Explain how medicines are manufactured, and how dosage forms influence entry of drugs to the body, how they are distributed, exert their pharmacological effect, and are removed from the body
3. Apply diagnostic reasoning tools to help establish a diagnosis.
4. Identify the different approaches to research design and study types used and undertake appropriate data collection and analysis to apply and present findings.

 

A 35-year-old man presents to your pharmacy with a 1-month history of intermittent upper abdominal pain, heart burn and nausea. He describes the pain as a dull, gnawing ache which is usually relieved by food or antacids. He had passed dark tarry stools the previous day and vomited earlier today. Upon questioning, he tells you that he has been taking three 500mg naproxen tablets (which he obtained via the internet) daily in the past two months to manage his back pain.He is normally fit and well with no past medical history. He smokes, drinks alcohol occasionally and exercises regularly. When asked about any recent weight loss, he indicates that he thinks he has lost some weight. You refer him onwards to the GP. After a few days, he attends your pharmacy with a prescription for medication to treat his recently diagnosed condition.

 

Each student needs to prepare a case study report based on the GI system teaching. This report will use a “feed forward” approach, giving you the opportunity to prepare your report and submit it Your report should consider the areas indicated as part of the marking scheme detailed below, providing appropriate levels of detail based on the percentage weighting assigned to each area. As a guide, you have 3000 words (+/- 10%) in total for the report, and you may wish to use approximately 2250 of these words for main body of the report, and the remaining 750 words for the annotation of your references. 

As part of your report, you should do the following:
1.    Establish how the diagnosis was reached based on the evidence provided
2.    Explain:
a.    how signs and symptoms of the condition are linked to the pathophysiology
b.    the mechanism(s) of action and rationale behind two treatment options for the patient
c.    the relevant dosage forms that are available for the two chosen treatment options
d.    how pharmacokinetics are linked to the normal dose for the two chosen treatment options
3.    Use appropriate literature sources for the information you provide, citing these sources within the text and annotating each reference.

Linking Symptoms to Pathophysiology

 

For the case study, you need to assess how the evidence provided in the case study support the diagnosis of the condition and discuss the rationale behind TWO named treatment options for the patient You will need to consider the aetiology and pathophysiology of the condition – not just stating it, but where possible explaining what is happening, and how this results in the individual’s symptoms. Whilst your case study may have given you some symptoms, they may not be comprehensive.

 

 It may be that a range of symptoms are possible, it may be that other symptoms appear if the condition has been occurring for longer. As part of your report, you could discuss these other symptoms, but should focus on those identified in the case study. It may also be relevant to discuss any available epidemiology data, and how this information has influenced the diagnosis. It is NOT intended that you should discuss why the evidence reveals it is not a different condition. It would only be if you had something that was very commonly ‘confused’ that any reference would be made and you should keep that brief.

When considering treatment options, you should discuss both pharmacological and non-pharmacological treatments.  This discussion could include any notable side effects for your chosen treatments, the appropriate dose and period of treatment, and the dosage forms that are available.

You need also to choose the appropriate dosage form for the patient and then explain about the design of that dosage form (e.g. coated tablet). In your discussion, you need to mention each excipient used in that formulation, what was the reason for using that material? and what was the benefit of adding that excipient into the formulation in terms of improving its bioavailability and stability. You need to mention in brief about the preparation steps of that formulation as well (e.g. wet granulation).

You must use the appropriate template you have been given to report your case study and consider whether the report would benefit from the inclusion of diagrams or tables. You should use Harvard style referencing to cite your sources of information.
You should aim to use a minimum of 10 and a maximum of 15 references for your report. To justify the inclusion of each reference, write a brief annotation (maximum of 75 words for each reference) explaining what information from that source you have used, why it is appropriate, and how you found that reference (e.g. data base and search terms). Note, the references themselves are not included in the word count for the submission.

Marking Criteria:
The assignment is based on four learning outcomes and will require the students to provide the following information:
Apply diagnostic reasoning tools to explain the diagnosis (30%).
1.    Relate how typical presenting symptoms would have been used to establish a diagnosis – this could include a consideration of relevant epidemiology and risk factors (10%).
2.    Discuss also what other diagnostic tests could have been ordered / used by the GP in order to confirm the diagnosis and rule out the differentials. (10%)
3.    Identify the appropriate steps to be taken in the management of the condition (10%).
Apply knowledge of anatomy, physiology and pathophysiology to recognise how conditions manifest themselves (15%).
4.    Describe in detail how typical symptoms that patients present with are linked to the pathophysiology of the condition (15%).
Explain how medicines are manufactured, and how dosage forms influence entry of drugs to the body, how they are distributed, exert their pharmacological effect, and are removed from the body (40%).
5.    Linked to specific guidelines, identify the first- and second-line therapy for your condition of choice including the normal dose when initiating treatment (5%).
6.    For each treatment, explain their mechanism of action in the treatment of the diagnosed condition (10%), explain the relevance of the composition of the standard dosage form and detail the pharmacokinetic properties (15%), and any significant side effects that may impact on adherence (10%).
Identify the different approaches to research design and study types used and undertake appropriate data collection and analysis to apply and present findings (15%).
7.    A minimum of 10 and a maximum of 15 different reference sources should be presented in an appropriate reference list and cited appropriately throughout the text using a Harvard referencing style.
8.    Briefly annotate 10 key references you have included explaining what information from that source you have used, why it is appropriate, and how you found that reference.