Case Study: Cirrhosis
Question 1
Mr. Vance has progressed through stage 1 to stage 3 of liver cirrhosis. Stage 1 liver cirrhosis presents with inflammation of the liver that leads to liver enlargement. This stage also presents with scarring of the liver. Besides, there are no complications at this stage. Stage 2 cirrhosis involves portal hypertension that worsens, and it is also usually accompanied by the development of varices. On the other hand, stage 3 marks decompensated cirrhosis (Suva, 2014). Also, it involves advanced scarring of the liver and the development of swelling in the patient's abdomen. The current stage of Mr. Vance is, therefore, stage 3, and its implications include possible liver failure and other serious complications such as liver cancer. Other possible implications include; ascites, edema, spider angiomas, and jaundice.
Question 2
The feeling of fatigue is a result of the reduced functionality of the liver. Since the liver has a role in metabolism, there is impaired metabolism and reduced energy leading to fatigue. Also, nausea is a result of the disorder in the liver, which then will send signals to the vomiting center in the brain hence leading to a sensation of nausea—the distended stomach results from enlargement of the liver and ascites (Suva, 2014). Due to decreased liver functioning, there is also decreased prothrombin levels, hemoglobin and albumin, increased ammonia levels, and serum bilirubin. As a result of the combined symptoms, one becomes easily irritable.
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Question 3
At this stage, the damage to the liver can no longer be reversed. However, with proper medication and lifestyle management, it can be managed. Therefore, the prognosis at this stage is poor (McCance & Huether, 2014). Some complications likely to occur following this stage of liver cirrhosis include; hepatocellular carcinoma, hepatic encephalopathy, bacteria peritonitis, and hepatorenal syndrome.
Case Study: Prostate Cancer
Question 1
Depending on the disease stage, the patient may present with a variety of symptoms ranging from increased urinary frequency, weak urinary stream, and urinary urgency (Riedel et al., 2015). A more advanced localized disease can present with urinary incontinence, hematospermia, hematuria, loin pain, dysuria, rectal tenesmus, or even suprapubic pain. Besides, PSA is elevated in prostate cancer patients.
Question 2
Factors that can predispose one to prostate cancer include old age, whereby the chance of getting prostate cancer is higher after age 50 and is lower in men below 40. Besides, family history is a factor whereby the probability of getting prostate cancer is high, where there is an inherited gene from a family member (McCance & Huether, 2014). Ethnicity is also a factor because men with African-American origin and Caribbean men with African ancestry have high probabilities of contracting the disease than men from other races. Other predisposing factors include; smoking, vasectomy, and STIs. As a result, the high-risk groups for prostate cancer include men with PSA levels higher than 20ng/ml, cancer stage T3a, N0, M0, and Gleason score between 8 and 10. Besides, smokers and elderly men are also at high risk of prostate cancer.
Question 3
Variation in prostate cancer growth ranges from stage I and differs all the way to stage IV. In the first stage, cancer is still within the prostate, and hence it is non-detectable by physical examination or imaging test. Stage II is similar to stage I; however, in this stage, cells grow faster and have a higher Gleason score. In stage III, cancer may begin to spread in the neighboring regions like the seminal. Besides, stage IV, which is the last stage of prostate cancer, metastasis occurs, and hence cancer spread to the liver, lymph nodes, lungs, bones, or bladder.
Question 4
If the diagnosis of prostate cancer takes place when it is still in the early stages, several treatment options should be considered. Depending on the cancer stage, a decision can be made on whether to treat or not treat cancer. For example, if in the early stages and one is young, there are several things to consider before starting treatment (McCance & Huether, 2014). For instance, one may prefer avoiding side effects that may result from treatment, such as erection problems and incontinence. However, others may be more concerned with destroying cancer rather than these side effects.
Question 5
Metastasis will lead to lethargy, bone pain, cord compression, anorexia, and weight loss. Bone pain can be treated by administering analgesics and biphosphates, such as zoledronic acid. These can also be treated using palliative care (Thompson et al., 2007). Anorexia and weight loss will also lead to tiredness and lethargy, and treatment could be by use of corticosteroids and megestrol acetate. Treatment of cord compression depends on the prognosis and performance status and can be by using steroids in high doses followed by surgery or early radiotherapy.
Case Study: Osteoarthritis
Question 1
Osteoarthritis is mainly associated with losing of articular cartilage whereby its glistening look disappears early in the disease and becomes brownish-grey or yellow-grey. Fibrillation takes place in the deeper layers, and the articular cartilage peels off at its surface as the disease progresses. The cartilage may be absent in some areas, and some regions become thin, hence leaving the subchondral bone without protection. Consequently, this bone becomes sclerotic, as in the case of Mr. Filstrup. Cysts may begin developing within the subchondral bone at times. After a while, it then communicates with the longitudinal fissures in the cartilages. (McCance & Huether, 2014). The cysts' contents are then released in the synovial cavity as a result of a build-up of pressure within, and on the way, it breaks via the articular cartilage. With time the cartilage erodes, and as a result, the osteocytes coating the cartilage may start growing outwards from the unprotected bone. This will then alter the joint’s anatomy and bone’s contours.
Question 2
NSAIDs and analgesics will help Mr. Filstrup manage this form of arthritis in that this therapy reduces pain and swelling and, hence, reduces symptoms (McCance & Huether, 2014). These NSAIDs work by inhibiting cyclooxygenase (COX), which is the enzyme that generates prostaglandin. Besides, aerobic exercise is recommended because it helps prevent the contraction of the joint capsule.
Question 3
In patients with osteoarthritis, the prognosis depends on the severity of the condition and the joints involved. Some clinical features are associated with a more rapid progression of knee arthritis-like in Mr. Filstrup. Such factors include old age, multiple involved joints, higher BMI, and Varus deformity. Since Mr. Filstrup is in overall good health and is still young, his probable prognosis for hip arthroplasty is good, generally exceeding 90%. Therefore, his general prognosis is good.
References
McCance, K. L., & Huether, S. E. (2014). Pathophysiology: The biologic basis for disease in adults and children . Elsevier Health Sciences.
Mora, J. C., Przkora, R., & Cruz-Almeida, Y. (2018). Knee osteoarthritis: pathophysiology and current treatment modalities. Journal of pain research , 11 , 2189.
Riedel, D. J., Cox, E. R., Stafford, K. A., & Gilliam, B. L. (2015). Clinical presentation and outcomes of prostate cancer in an urban cohort of predominantly African American, human immunodeficiency virus-infected patients. Urology , 85 (2), 415-422.
Suva, M. A. (2014). A Brief Review on Liver Cirrhosis: Epidemiology, Etiology, Pathophysiology, Symptoms, Diagnosis, and Its Management. Inventi Rapid: Molecular Pharmacology .
Thompson, J. C., Wood, J., & Feuer, D. (2007). Prostate cancer: palliative care and pain relief. British medical bulletin , 83 (1), 341-354.
