Case studies

Laboratory for Diagnosis Symptom and Illness Management

Miami Regional University

Question Description

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

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Inflammatory Bowel Disease Case Study The patient is an 11-year-old girl who has been complaining of intermittent right lower quadrant pain and diarrhea for the past year. She is small for her age. Her physical examination indicates some mild right lower quadrant tenderness and fullness. Studies Hemoglobin (Hgb), Hematocrit (Hct), Vitamin B12 level, Meckel scan, D-Xylose absorption, Results 8.6 g/dL (normal: >12 g/dL) 28% (normal: 31%-43%) 68 pg/mL (normal: 100-700 pg/mL) No evidence of Meckel diverticulum 60 min: 8 mg/dL (normal: >15-20 mg/dL) 120 min: 6 mg/dL (normal: >20 mg/dL) Lactose tolerance, Small bowel series, No change in glucose level (normal: >20 mg/dL rise in glucose) Constriction of multiple segments of the small intestine Diagnostic Analysis The child's small bowel series is compatible with Crohn disease of the small intestine. Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive regimen, and her condition improved significantly. Unfortunately, 2 years later she experienced unremitting obstructive symptoms and required surgery. One year after surgery, her gastrointestinal function was normal, and her anemia had resolved. Her growth status matched her age group. Her absorption tests were normal, as were her B12 levels. Her immunosuppressive drugs were discontinued, and she is doing well. Critical Thinking Questions 1. Why was this patient placed on immunosuppressive therapy? 2. Why was the Meckel scan ordered for this patient? 3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease? (always on boards) 4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease? Urinary Obstruction Case Studies The 57-year-old patient noted urinary hesitancy and a decrease in the force of his urinary stream for several months. Both had progressively become worse. His physical examination was essentially negative except for an enlarged prostate, which was bulky and soft. Studies Routine laboratory studies Intravenous pyelogram (IVP) Uroflowmetry with total voided flow of 225 mL Cystometry Electromyography of the pelvic sphincter muscle Cystoscopy Prostatic acid phosphatase (PAP) Prostate specific antigen (PSA) Prostate ultrasound Results Within normal limits (WNL) Mild indentation of the interior aspect of the bladder, indicating an enlarged prostate 8 mL/sec (normal: >12 mL/sec) Resting bladder pressure: 35 cm H2O (normal: <40 cm H2O) Peak bladder pressure: 50 cm H2O (normal: 40-90 cm H2O) Normal resting bladder with a positive tonus limb Benign prostatic hypertrophy (BPH) 0.5 units/L (normal: 0.11-0.60 units/L) 1.0 ng/mL (normal: <4 ng/mL) Diffusely enlarged prostate; no localized tumor Diagnostic Analysis Because of the patient’s symptoms, bladder outlet obstruction was highly suspected. Physical examination indicated an enlarged prostate. IVP studies corroborated that finding. The reduced urine flow rate indicated an obstruction distal to the urinary bladder. Because the patient was found to have a normal total voided volume, one could not say that the reduced flow rate was the result of an inadequately distended bladder. Rather, the bladder was appropriately distended, yet the flow rate was decreased. This indicated outlet obstruction. The cystogram indicated that the bladder was capable of mounting an effective pressure and was not an atonic bladder compatible with neurologic disease. The tonus limb again indicated the bladder was able to contract. The peak bladder pressure of 50 cm H2O was normal, again indicating appropriate muscular function of the bladder. Based on these studies, the patient was diagnosed with a urinary outlet obstruction. The PAP and PSA indicated benign prostatic hypertrophy (BPH). The ultrasound supported that diagnosis. Cystoscopy documented that finding, and the patient was appropriately treated by transurethral resection of the prostate (TURP). This patient did well postoperatively and had no major problems. Critical Thinking Questions 1. 2. 3. 4. 5. Does BPH predispose this patient to cancer? Why are patients with BPH at increased risk for urinary tract infections? What would you expect the patient’s PSA level to be after surgery? What is the recommended screening guidelines and treatment for BPH? What are some alternative treatments / natural homeopathic options for treatment? ...
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Case Study One
Inflammatory Bowel Disease
As it is made clear in the case study, the patient is an 11-year-old who has been diagnosed with a
small bowel whose series is compatible and similar to the Crohn disease. This is a disease that is
associated with the small intestine. This being the main diagnosis, there are a series of treatments
that the 11-year patient is bound to undergo in order to fall back on the recovery path. The
following is a justification of some of the treatments;
Why the patient was placed on immunosuppressive therapy
In order to fully understand why the patient was placed in immunosuppressive therapy, it is very
important first of all to understand how immunosuppressive therapy works and where it is used
in medication. In simple words, immunosuppressive therapy is used to help as a base in
conducting surgeries involving transplants.
Underlining the fact that the patient underwent surgery, it is relevant and appropriate that he was
placed under immunosuppressive therapy. The only question, however, is why was he
specifically paved under this kind of therapy and not any other related therapy that corresponds
to his current situation and health status?
The main reason as to why the patient was placed in immunosuppressive therapy is in order to
lower his body's immune response. Due to the fact that the patient is an 11-year-old, and might,
therefore, have an active immune system, this therapy is used to help in putting all that under
control. It is also very important to underline the fact that the immunosuppressive therapy goes
all the way to helping doctors to stop the immune system from overreacting and consequently

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