NR 507
PATHOPHYSIOLOGY WEEK
3 TD1 Vascular, Cellular and
Hematologic Disorders
Discussion Part One A 17-year-old African American from the inner city complains of severe chest and abdominal pain. Upon examination the attending physician performs and EKG, chest x-ray, and an abdominal and chest clinical examination and finds nothing. Assuming, she is drug seeking he sends her home. She comes back to the ER 4 hours later and now you see the patient. She explains that she was running track this Week 3: Cardiovascular, Cellular, and Hematologic Disorders - Discussion Part One
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This week's graded topics relate to the following Course Outcome s (COs). 1Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)
2Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)
3Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)
4Distinguish risk factors associated with selected disease states. (PO 1)
5Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)
6Distinguish risk factors associated with selected disease states. (PO 1)
7Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)Discussion
Discussion Part One (graded) past afternoon at school and that despite being very hot (100 F) she pushed on. Afterwards, she starts feeling extensive pain in her chest and abdomen. She has jaundiced eyes, her blood pressure is 98/50, pulse is 112, T = 99.9 F, R = 28. The pain seems out of proportion to the physical findings.
What is your list of differential diagnoses in this case and explain how each of these fits with the case patient as described above. Be sure to list at least four (4) pertinent differential diagnoses. Indicate which of these you would select as the most likely diagnosis and explain why.
Now, as she is in the ER she begins to exhibit stroke like features. ? Does this change your differential?
How do you treat this patient now? Are they any preventative actions that could have been taken?0
Responses
5/15/2016 7:54:30 PM Rechel DelAntar
Differential Diagnoses
Hello Professor and Class,
Differential Diagnoses A case of a 17 year old African American from the inner city complaining of sever chest and abdominal pain seen in the ER but was released after clinical examinations and tests reveal no abnormalities with the assumption that the patient is drug seeking. She comes back 4 hours after running track in school with symptoms of extensive chest and abdominal pain and jaundice and expressed low-grade fever of 100F earlier. BP 98/50, tachycardic at 112 RR=28. Once n the ER, patients symptoms have progressed to exhibiting stroke like features. Based on the patient’s presentation and symptoms, patient may have:
1.Sickle Cell Disease –The term sickle cell disease (SCD) describes a group of inherited red blood cell disorders. People with SCD have abnormal hemoglobin, called hemoglobin S or sickle hemoglobin, in their red blood cells. In SCD, a person inherits 2 abnormal genes, one from each parent. In all forms, one of the genes causes the production of hemoglobin S. In the case of Sickle cell anemia, a patient has 2 hemoglobin S, hemoglobin SS. Among all the types of SCD, sickle cell anemia is the most common type (National Heart, Lung and Blood Institute, 2015). Normally, red blood cells are flexible and round, moving easily through the blood vessels. In sickle cell disease, red blood cells become rigid and sticky and shaped like sickles/crescent moons. These irregularities causes the cells to get stuck in small blood vessels, which can slow or block blood flow and decrease oxygen supply to parts of the body. Pain is the major symptom when the patient is in “crisis”. Pain develops when sickle-shaped red blood cells block blood flow through tiny blood vessels to your chest, abdomen and joints. Pain is sporadic and can last for hours or weeks. Continued poor oxygen supply to organs may eventually lead to organ damage. Stroke is a common manifestation of the disease because of blood flow obstruction (Mayo Clinic, 2014). This diagnosis fits the patient’s presentation and her experiencing signs of stroke is one of the symptoms of the disease.
2.Hemochromatosis -causes your body to absorb too much iron from the food you eat. Excess iron is stored in your organs, especially your liver, heart and pancreas. Too much iron can lead to life-
threatening conditions, such as liver disease, heart problems and diabetes. Symptoms include abdominal pain, weakness, fatigue, heart failure such as chest pain and liver failure (National Institute of Diabetes and Digestive and Kidney Disease, 2014). Although some of these symptoms are similar to the one in the case study, hemochromatosis occurs mostly among Caucasians and the pain in this disease is more chronic and not severe which does not fit the profile of the patient.
3.G6PD –Glucose -6-dehydrogenase Deficiency is a hereditary type of hemolytic anemia in which red blood cells break down when the body is exposed to certain drugs or the stress of infection. It is common between Mediterranean and African origin and is characterized by abnormally low levels of glucose-6-phosphate dehydrogenase, an enzyme involved in the pentose phosphate that is especially important in the red blood cell. G6PD deficiency is the most common human enzyme defect. There is no specific treatment, other than avoiding known triggers. Symptoms include jaundice, fever, fatigue, tachycardia and abdominal pain from splenomegaly and hyperbilirubinimia (US National Library of Medicine, 2016). Although some of the symptoms fit the case study, patients with G6PD do not experience chest pain. Also the pain experienced in patients with this disease are not as severe as the one described n the case study. This disease also does not lead to stroke like symptoms.
4.Heart Failure -often referred to as congestive heart failure (CHF), occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs. There are different types of heart failure, there is right sides or left sided heart failure referring to the side of the heart being affected. There is also systolic or diastolic heart failure. When the condition is severe, blood backs up to the lungs causing elevated pulmonary pressure and congestion leading to right sided heart failure (cor pulmonale). Backward failure of the right ventricle leads to congestion of systemic capillaries. This generates excess fluid accumulation in the body causing congestion in other organs. Symptoms include chest pain, shortness of breath, tachycardia, jaundice and coagulopathy (from impaired liver function from congestive hepatopathy), abdominal distention and pain (McDonagh, T., 2011). Although some of the symptoms are the same as the case study, these symptoms do not occur suddenly. Heart Failure occurs over time and would not have allowed the patient to be able to run track because at this stage of symptomatology, the patient would have been very debilitated that ambulating short distances would render them dyspnic. 5.Leukemia -is a clonal malignant disorder of leukocytes in the blood and blood -forming organs. The common feature of all forms of leukemia is an uncontrolled proliferation of malignant leukocytes, causing an overcrowding of bone marrow and decreased production and function of normal hematopoietic cells. There are different types of leukemia, Acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL) progress much faster and symptoms may worsen more quickly than with the chronic leukemias (CML and CLL) (Mc,Cance, K.L., et. al., 2013). Symptoms include fever, fatigue, weakness, abdominal pain, easy bruising and petechiae. Although some symptoms match that of the patient in the case study, leukemia does not show symptoms of chest pain or jaundice as well as stroke and does not for the case study. References:
Mayo Clinic. (2014). Diseases and Conditions: Sickle Cell Anemia . Retrieved from
http://www.mayoclinic.org/diseases -conditions/sickle -cell-anemia/basics/symptoms/con -
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McCance, K.L., Huether, S.E., Brashers, V.L. and Rote, N.S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7ed.). St. Louis, MO: Mosby.
McDonagh, T. (2011). Oxford textbook of heart failure. Oxford: Oxford, University Press. National Institute of Diabetes and Digestive and Kidney Disease. (2014). Hemochromatosis. Retrieved from http://www.niddk.nih.gov/health - information/health-topics/liver-disease/hemochromatosis/Pages/facts.aspx.
National Heart, Lung and Blood Institute. (2015). What is sickle cell disease? Retrieved from http://www.nhlbi.nih.gov/health/health -topics/topics/sca .
US National Library of medicine. (2016 ). Glucose -6-phosphate dehydrogenase Deficiency. Retrieved from https://ghr.nlm.nih.gov/condition/ glucose-6-phosphate-dehydrogenase-deficiency. .
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5/16/2016 10:59:33 PM Rechel DelAntar reply to Rechel DelAntar
RE: Differential Diagnoses
The signs and symptoms of sickle cell disease are caused by the sickling of red blood cells. Painful episodes can occur when sickled red blood cells, which are stiff and inflexible, get stuck in small blood vessels. These episodes deprive tissues and organs of oxygen-rich blood and can lead to organ damage, especially in the lungs, kidneys, spleen, and brain. A particularly serious complication of sickle cell disease is high blood pressure in the blood vessels that supply the lungs (pulmonary hypertension). Pulmonary hypertension occurs in about one-third of adults with sickle cell disease and can lead to heart failure. The rapid breakdown of red blood cells may also cause yellowing of the eyes and skin, which are signs of jaundice. Since sickle cell is
