How to treat a Urinary and Reproductive Function Case Study (Solved)

How to treat a Urinary and Reproductive Function Case Study (Solved)

Urinary Function: Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder.

Case Study Questions
1. The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.
2. Create a list of risk factors the patient might have and explain why.
3. Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.

Reproductive Function:
Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.
Microscopic Examination of Vaginal Discharge
(-) yeast or hyphae
(-) flagellated microbes
(+) white blood cells
(+) gram-negative intracellular diplococci

Case Study Questions
1. According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probably diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.
2. Based on the vaginal discharged described and the microscopic examination of the sample could you suggest which would be the microorganism involved?
3. Name the criteria you would use to recommend hospitalization for this patient

SOLUTION TO Acute Kidney Injury

Acute kidney injury is a sudden failure or decline in the ability of the kidney to perform its normal function (Myhre and Sifris, 2022). Acute kidney injury is also referred to as acute renal failure or acute kidney failure. It occurs when the kidney loses its ability to filter waste products. Acute kidney injury is divided into three types depending on the cause; prerenal, renal and postrenal.

Mr J.R presented with vomiting and diarrhoea for 48 hours, weakness and dizziness, paleness and sweating. Also, he has continued to experience nausea, vomiting (not able to tolerate any solid foods or liquids) and diarrhoea (5-6 watery bowel movements), which are classical signs and symptoms of prerenal acute kidney injury. Prerenal acute kidney injury is caused by reducing blood flow to the kidneys. It is caused by severe dehydration, including chronic vomiting and diarrhoea (Myhre and Sifris, 2022). Furthermore, it is manifested by body weakness, dizziness, and pale and sweaty skin, all present in Mr J.R’s report.

Risks factors

The risk factors for Mr R to develop acute kidney injury are old age (73 years old) and sex (male). Older age is associated with comorbidities that might facilitate AKI, for example, Congestive heart failure (Coca, 2022). Also, the comorbidities may require procedures and medications that may be kidney stressors and nephrotoxins. Furthermore, kidneys undergo age-dependent structural and functional alterations making patients vulnerable to developing AKI (Coca, 2022). Male have higher testosterone levels than females. Increased testosterone level is associated with loss in kidney function, making males more susceptible to AKI than females.

Complications of chronic kidney failure in the hematologic system

The kidney is responsible for producing erythropoietin (EPO). In chronic renal failure, kidneys won’t make enough erythropoietin affecting their ability to make red blood cells resulting in anaemia. Also, chronic kidney injury cause alterations in the coagulation cascade, leading to delayed clot formation, decreased clot breakdown and increased final clot strength (Nunns et al., 2022). In chronic renal failure, there is a total loss of kidney functions, which can lead to hypocalcemia, metabolic acidosis, renal osteodystrophy, hyperphosphatemia and secondary hyperparathyroidism.

Reproductive case study

Ms P.C presents with a history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal fluid. Also, she reports abdominal vaginal discharge, which she describes as “thick, greenish-yellow in color and very smelly.” These are classical features of gonorrhoea supported by the presence of gram-negative intracellular diplococci. Furthermore, the microorganism involved is Neisseria gonorrhoeae, whose presence in the body is manifested by the above features. Apart from gonorrhea, Neisseria gonorrhea can ascend urogenital tract causing acute pelvic inflammatory disease (peritonitis, endometritis and salpingitis) in females, urethritis or epididymitis in males (McSheffrey and Gray-Owen, 2022). Also, it can disseminate from fallopian tubes via peritoneum to liver capsules causing perihepatitis. Finally, it can invade blood vessels and lymphatic system to cause inguinal lymphadenopathy and disseminated gonococcal infection.

I will recommend hospitalization for Ms P.C on the following occasions. Worsen of the condition, i.e., severe pain, persistent nausea and vomiting and high-grade fever (Bruce, 2022). In addition, failure of outpatient treatment, presence of pregnancy, Tubo- ovarian abscess will  and immunodeficiency will warrant immediate hospitalization

References

Bruce, 2022. Emergent Management of Gonorrhea: Overview, Consultations, Antibiotic Treatment. [online] Emedicine.medscape.com. Available at: <https://emedicine.medscape.com/article/782913-overview> [Accessed 30 May 2022].

Coca, S., 2022. Acute Kidney Injury in Elderly Persons. [online] Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902696/#:~:text=1996%20and%202003.-,The%20incidence%20rate%20of%20AKI%20is%20increasing%20over%20time%20in,oldest%20stratum%20(%E2%89%A5%2080).> [Accessed 30 May 2022].

McSheffrey, G. and Gray-Owen, S., 2022. Neisseria gonorrhoeae. [online] Available at: <https://www.sciencedirect.com/topics/medicine-and-dentistry/neisseria-gonorrhoeae#:~:text=Neisseria%20gonorrhoeae%20is%20a%20bacterial,or%20disseminates%20to%20distal%20tissues.> [Accessed 30 May 2022].

Myhre, J. and Sifris, D., 2022. What Are the Signs and Symptoms of Acute Renal Failure?. [online] Verywell Health. Available at: <https://www.verywellhealth.com/symptoms-of-acute-renal-failure-4163965#:~:text=Prerenal%20AKI%20Symptoms,-Acute%20kidney%20injury&text=Examples%20of%20this%20include%3A,sitting%20up%20(%20orthostatic%20hypotension%20).> [Accessed 30 May 2022].

Nunns, G., Moore, E., Chapman, M., Moore, H., Stettler, G., Peltz, E., Burlew, C., Silliman, C., Banerjee, A. and Sauaia, A., 2022. The hypercoagulability paradox of chronic kidney disease: The role of fibrinogen. [online] Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693753/#:~:text=Patients%20with%20CKD%20manifest%20a,fibrinogen%20levels%20in%20CKD%20patients.> [Accessed 30 May 2022].

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