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Case Overview Of Patient With Rectal Bleeding

Case Overview Of Patient With Rectal Bleeding

Case overview

AO is a 28years old female presenting with rectal bleeding and weakness associated with daily bowel movements with significant diarrhea. She has no history of traveling outside the city, hospitalization, and taking antibiotics. A proctosigmoidoscopy shows pseudopolyps formation. Colon biopsies reveal erosions of the mucosa and ulceration into the mucosa mixed with neutrophils, lymphocytes, and macrophages inflammatory cells. Inflammation is limited to the rectum and sigmoid colon only. There are no dysplastic cells suggesting cancer of the colon.

  1. What is the relevance of the last sentence in the first paragraph: “She has not traveled outside of the city, been hospitalized, or received antibiotics recently”?

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Diarrhea is the passage of loose stools for more than three episodes per day. It is an infection of the gastrointestinal system by bacteria and parasitic organisms contaminated by food and water from one person to the other through poor hygiene. However, traveling, antibiotics, and hospitalization cause diarrhea. Travelling causes diarrhea due to exposure to parasites, bacteria, or consumption of contaminated food and water (Leung, et al, 2019). Hospitalization increases the risk for colonization with bacteria such as clostridium difficile. The bacteria invade the large intestines and produce damaging toxins and produce inflammatory cells, hence diarrhea. Taking antibiotics alters the normal bacteria in the intestines. This causes digestion irritation and diarrhea.

  1. What is the diagnosis? Explain your answer. Why and how did you come up with this diagnosis?

Irritable bowel syndrome is a functional gastrointestinal disorder characterized by abdominal pain, change in bowel habits, rectal bleeding, anorexia, malaise, dehydration, post-prandial urgency, and bloating. In irritable bowel syndrome, the patient has gastrointestinal motility, psychopathology, and visceral hyperalgesia (Lacy, et al, 2021)Case Overview Of Patient With Rectal Bleeding. Gastrointestinal motility presents with alternating episodes of postprandial diarrhea and constipation due to smooth muscle hyperresponsiveness. Visceral hyperalgesia is a result of gastric motility that causes abdominal pain and other referred pain due to distension and bloating. Changes in microbiota cause influence brain function by changing the person’s behavior and cognition. Irritable bowel syndrome causes an increase in the mucosal lymphocytes and enteroendocrine cells. Irritable bowel is the patient’s diagnosis because she presents with acute changes in bowel movement, weakness, rectal bleeding, and diarrhea. She has increased inflammatory cells such as lymphocytes, macrophages, and neutrophils.

  1. Identify eight abnormal laboratory blood test values and provide a brief pathophysiological explanation for each of them.

The abnormal tests are low potassium at 3.1 due to dehydration resulting from diarrhea. ESR indicates inflammation and is high at 24mm/hr. The blood hemoglobin levels are at 10g/dl due to bleeding. HCO+3 or bicarbonate is low due to metabolic acidosis resulting from diarrhea and blood loss. The chloride level is high are 108 due to dehydration and metabolic acidosis. The fasting blood sugar is high due to dehydration and loss of electrolytes such as potassium. Diarrhea causes total protein loss hence the reduced albumin and total proteins.

References

Lacy, B. E., Pimentel, M., Brenner, D. M., Chey, W. D., Keefer, L. A., Long, M. D., & Moshiree, B. (2021). ACG clinical guideline: management of irritable bowel syndrome. Official journal of the American College of Gastroenterology| ACG, 116(1), 17-44. https://doi.org/10.1016/j.cell.2020.08.007

Leung, A. K., Leung, A. A., Wong, A. H., & Hon, K. L. (2019). Travelers’ diarrhea: a clinical review. Recent patents on inflammation & allergy drug discovery, 13(1), 38-48. https://doi.org/10.2174/1872213X13666190514105054 Case Overview Of Patient With Rectal Bleeding

A.O. is a 28-year-old woman who presents to your clinic with complaints of rectal bleeding and weakness. Five days ago, she noticed bright red blood in her stools. Furthermore, she reports that her daily bowel movements have increased to five or six with significant diarrhea. She has been weak for approximately three days. She has not traveled outside of the city, been hospitalized, or received antibiotics recently.

A proctosigmoidoscopy was conducted three days after the patient’s discharge from the acute care clinic. A significant pseudopolyps formation could be seen. Biopsies of the colon revealed erosions of the mucosa and ulcerations into the submucosa with mixed acute (i.e., neutrophils) and chronic (lymphocytes and macrophages) inflammatory cells. No dysplastic cells suggesting the development of colon carcinoma were seen. No multinucleated giant cells suggesting Crohn’s disease were seen. Inflammation and ulceration were limited to the rectum and sigmoid colon only. Crypts of Lieberkühn were intensely inflamed. Marked hemorrhaging of capillaries in the mucosa was also observed Case Overview Of Patient With Rectal Bleeding.

Laboratory Blood Test Results

Na+ = 143 meq/L
BUN = 20 mg/dL
Plt = 315,000/mm3
AST = 33 IU/L
K+ = 3.2 meq/L
Cr = 1.1 mg/dL
PO4-3 = 4.0 mg/dL
ESR = 24 mm/hr
ALT = 41 IU/L
Cl- = 108 meq/L
Hb = 10.8 g/dL
CRP = 1.5 mg/dL
T bilirubin = 0.9 mg/dL
Alb = 3.1 g/dL
HCO+3 = 18 meq/L
Hct = 36%
Ca+2 = 8.9 mg/dL
PT = 11.3 sec
Glu, fasting = 132 mg/dL
WBC = 9,400/mm3
Questions

1. What is the relevance of the last sentence in the first paragraph: “She has not traveled outside of the city, been hospitalized, or received antibiotics recently”? Explain your answer in detail.

2. What is the diagnosis? Explain your answer. Why and how did you come up with this diagnosis?

3. Identify eight abnormal laboratory blood test values and provide a brief pathophysiological explanation for each of them  Case Overview Of Patient With Rectal Bleeding

Discussion Forum Sample

Discussion questions in NUR-631 are presented with a range of options.

Read the questions carefully and follow directions regarding whether to select one, two or answer multiple questions for the response. Present responses using the sample format provided below and include at least two citations from peer-reviewed journals published within the last 5 years or from the textbooks. References must be in proper APA format. A substantive responses must be at least 150 words in length and pertain to the topic as it relates to pathophysiology.

Sample DQ

Select one of the following discussion questions for your discussion response.

  1. What did Mark Twain mean when he said, “the difference between the right word and the almost right word is the difference between lightning and the lightning bug”? Demonstrate your answer by providing an example from your own life when “almost the right word” created confusion, misunderstanding, or adversity.
  2. How can knowing your fellow students and fostering a sense of community benefit your educational experience?
  3. Part of effective communication involves knowing how to respond rather than react to something someone has said or written. In the online classroom format, why is it important to read a classmate’s post and assess that person’s intended message before you offer a response? How can this skill of responding help you in your career?Case Overview Of Patient With Rectal Bleeding

Sample Student DQ Response Format

What did Mark Twain mean when he said, “the difference between the right word and the almost right word is the difference between lightning and the lightning bug”? Demonstrate your answer by providing an example from your own life when “almost the right word” created confusion, misunderstanding, or adversity.

It is very important to use the right words when communicating. If you do not select your words carefully you can end up not getting your point across or miss a great opportunity. Using the right word makes sure you are understood correctly. If you are not careful about the words you use, it is easier for people to misinterpret them. This can have a negative impact in the medical field, as miscommunication affects “patients’ quality of care, health outcomes, adherence to treatment and satisfaction” and is also cited as the “most common reason for patient medical complaints” (Morgan, 2013, p. 123)Case Overview Of Patient With Rectal Bleeding.

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I have experienced what the difference between the “right word” and the “almost right word” can do. A couple years ago I was having a tough time. I was really busy with a lot of different things and my family could tell it was wearing me down. One day my daughter came up and handed me a picture she drew of the two of us. I was in the middle of something and just took it and said, “Oh, that’s nice, thanks.” Later, I could see she was sad. I felt terrible and thought about how much work she put into the picture for me, and how she was trying so hard to make me happy. I used almost the right words, but not the right words. We both felt much better after I took the time to express how I really felt.

Reference:

Morgan, S. (2013). Miscommunication between patients and general practitioners: Implications
for clinical practice. Journal of Primary Health Care, 5(2), 123-128. Case Overview Of Patient With Rectal Bleeding