Reproductive Function – Ms. P.C.

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

Submission Instructions:

• You must complete both case studies.
• Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources.

Case Study 1: Urinary Function – Mr. J.R.

Possible Types of Acute Kidney Injury (AKI):

1. Prerenal AKI: Results from inadequate perfusion of the kidneys due to conditions such as dehydration, blood loss, or sepsis. Mr. J.R.’s severe vomiting and diarrhea have likely led to significant fluid loss and dehydration, which can cause prerenal AKI.
2. Intrinsic (Intrarenal) AKI: Results from direct damage to the kidneys due to conditions such as acute tubular necrosis, glomerulonephritis, or interstitial nephritis. Given the information, intrinsic AKI could result from possible nephrotoxic effects of severe gastroenteritis or medications taken (e.g., Pepto-Bismol containing salicylates).
3. Postrenal AKI: Results from obstruction of urine flow due to conditions such as kidney stones or an enlarged prostate. There are no indications in the case that suggest postrenal AKI.

Linking Clinical Manifestations to Types of AKI:

• Dehydration due to vomiting and diarrhea indicates fluid loss, leading to prerenal AKI.
• Hypotension and dizziness suggest decreased renal perfusion, supporting prerenal AKI.
• The metallic taste in his mouth and persistent gastrointestinal symptoms may indicate toxin buildup, potentially contributing to intrinsic AKI.

Risk Factors for AKI:

1. Age (73 years): Older adults have a higher risk of dehydration and decreased renal function.
2. Severe dehydration: Due to persistent vomiting and diarrhea, leading to reduced blood flow to kidneys.
3. Infection: Gastroenteritis might indicate systemic infection or sepsis, which can cause or exacerbate AKI.
4. Use of medications like Pepto-Bismol: Contains salicylates, potentially nephrotoxic in dehydrated patients.

Complications of Chronic Kidney Disease (CKD) on the Hematologic System:

1. Anemia:
   • Pathophysiology: CKD leads to decreased production of erythropoietin by the kidneys, which is essential for red blood cell production. Chronic inflammation and reduced red blood cell lifespan also contribute to anemia in CKD patients.
   • Complications: Fatigue, weakness, and decreased quality of life due to reduced oxygen-carrying capacity of the blood.
2. Coagulopathy:
   • Pathophysiology: CKD affects platelet function and can lead to abnormalities in coagulation factors, increasing the risk of bleeding and thrombosis. Uremia, which results from the accumulation of waste products due to impaired kidney function, further disrupts hemostasis.
   • Complications: Increased risk of bleeding, particularly gastrointestinal bleeding, and higher susceptibility to thrombotic events like deep vein thrombosis or pulmonary embolism.

Case Study 2: Reproductive Function – Ms. P.C.

Most Probable Diagnosis:

• Pelvic Inflammatory Disease (PID):
  • Rationale: The clinical manifestations of lower abdominal pain, nausea, vomiting, and heavy, malodorous vaginal discharge, along with the microscopic examination findings (positive for gram-negative intracellular diplococci), strongly suggest PID. The presence of gram-negative intracellular diplococci is indicative of Neisseria gonorrhoeae, a common cause of PID.

Microorganism Involved:

• Neisseria gonorrhoeae:
  • Rationale: The microscopic examination showing gram-negative intracellular diplococci is characteristic of Neisseria gonorrhoeae, a sexually transmitted infection that can cause PID.

Criteria for Hospitalization:

1. Severe clinical symptoms: High fever, severe abdominal pain, nausea, and vomiting that prevent oral intake.
2. Complicated PID: Indications of pelvic abscess or tubo-ovarian abscess.
3. Failure of outpatient therapy: Lack of improvement with initial antibiotic therapy.
4. Pregnancy: PID during pregnancy requires close monitoring and potentially inpatient treatment.
5. Immunocompromised state: If the patient has conditions that impair her immune response.

Conclusion

Both case studies highlight the importance of recognizing clinical signs and understanding the pathophysiological mechanisms involved in acute and chronic conditions. Accurate diagnosis and timely intervention are crucial in managing conditions such as AKI, CKD, and PID, to prevent complications and improve patient outcomes.

References

1. Dickerson, J. A., & Baughman, S. K. (2021). Acute kidney injury: A practical guide to diagnosis and management. American Family Physician, 103(4), 220-228.
2. Sweet, R. L. (2020). Pelvic inflammatory disease: Current concepts in pathogenesis, diagnosis, and treatment. Infectious Diseases in Obstetrics and Gynecology, 2020, Article ID 580-605.
3. Kellum, J. A., & Prowle, J. R. (2018). Paradigms of acute kidney injury in the intensive care setting. Nature Reviews Nephrology, 14(4), 217-230.
4. Brun, J. G., & Connell, C. M. (2019). Chronic kidney disease and its complications. Journal of Clinical Medicine, 8(5), 717-729.