Scenario: A 65-year-old obese African American male patient presents to his HCP with crampy left lower quadrant pain, constipation, and fevers to 101˚ F. He has had multiple episodes like this one over the past 15 years and they always responded to bowel rest and oral antibiotics. He has refused to have the recommended colonoscopy even with his history of chronic inflammatory bowel disease (diverticulitis), sedentary lifestyle, and diet lacking in fiber. His paternal grandfather died of colon cancer back in the 1950s as well. He finally underwent colonoscopy after his acute diverticulitis resolved. Colonoscopy revealed multiple polyps that were retrieved, and the pathology was positive for adenocarcinoma of the colon.
To prepare:
By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
The Assignment (1- to 2-page case study analysis)
Develop a 1- to 2-page case study analysis in which you:
Explain why you think the patient presented the symptoms described.
Identify the genes that may be associated with the development of the disease.
Explain the process of immunosuppression and the effect it has on body systems.
Case Study Analysis
Patient Presentation: The 65-year-old obese African American male patient presented to his healthcare provider (HCP) with crampy left lower quadrant pain, constipation, and fevers. He has a history of chronic inflammatory bowel disease (diverticulitis) and has experienced multiple similar episodes over the past 15 years. These episodes have typically responded to bowel rest and oral antibiotics. Despite recommendations, the patient has refused to undergo a colonoscopy. However, after his most recent episode of diverticulitis, he finally agreed to the procedure, which revealed multiple polyps positive for adenocarcinoma of the colon.
Reason for Symptoms: The patient’s symptoms of crampy left lower quadrant pain, constipation, and fevers can be attributed to the complications of diverticulitis. Diverticulitis is characterized by the inflammation or infection of diverticula, which are small pouches that develop in weak areas of the colon wall. When these diverticula become inflamed or infected, it leads to symptoms such as abdominal pain, changes in bowel habits (such as constipation), and sometimes fever.
Genes Associated with the Disease: In the case of colon cancer, certain genes have been associated with its development. The patient’s paternal grandfather’s history of colon cancer further increases the suspicion of a genetic component in this case. While specific genetic testing would be required to confirm, some commonly known genes associated with colon cancer include APC (adenomatous polyposis coli), TP53 (tumor protein 53), and mismatch repair genes (MLH1, MSH2, MSH6, PMS2). Mutations or alterations in these genes can predispose individuals to the development of colorectal cancer.
Immunosuppression and its Effects on Body Systems: Immunosuppression refers to the reduction or suppression of the immune system’s activity. It can be intentional, such as in cases where organ transplantation is performed, or it can occur as a result of certain medical conditions or medications. Immunosuppression can have significant effects on various body systems.
The immune system plays a crucial role in identifying and eliminating abnormal cells, including cancer cells. When the immune system is suppressed, its ability to recognize and destroy cancer cells becomes compromised. This allows cancer cells to grow and proliferate, increasing the risk of cancer development.
In the context of the patient’s chronic inflammatory bowel disease and the use of immunosuppressive medications, such as corticosteroids, the immunosuppression can further contribute to the development and progression of cancer. Chronic inflammation in the colon, as seen in diverticulitis and inflammatory bowel disease, can lead to DNA damage and genetic mutations, which can promote the formation of cancer cells. The immunosuppression caused by medications can hinder the immune system’s ability to detect and eliminate these abnormal cells, facilitating the development of adenocarcinoma of the colon.
In conclusion, the patient’s symptoms can be attributed to the complications of diverticulitis. The presence of multiple polyps positive for adenocarcinoma of the colon suggests a potential genetic predisposition to colon cancer, supported by the patient’s family history. The chronic inflammatory bowel disease and immunosuppressive medications further contribute to the development and progression of cancer by promoting DNA damage and impairing the immune system’s ability to recognize and eliminate abnormal cells.