Discussion 4

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:

  • Complete both case studies.
  • Your initial post should be at least 500 words per case study, formatted and cited in current APA 7 style with support from at least 3 academic sources.
  • Due Wednesday April 3rd at 11:59pm

Reproductive Function

Case Study 1: Urinary Function

  1. Types of Acute Kidney Injury (AKI) and Clinical Manifestations:

    Acute kidney injury can be categorized into three main types: prerenal, intrinsic, and postrenal.

    • Prerenal AKI: This type occurs due to decreased blood flow to the kidneys, leading to reduced perfusion and subsequent injury. In Mr. J.R.’s case, his clinical manifestations such as fever, nausea, vomiting, and diarrhea could lead to dehydration and hypovolemia, causing reduced renal perfusion. The history of watery bowel movements further supports the possibility of dehydration, exacerbating prerenal AKI.
    • Intrinsic AKI: This type involves damage to the kidney tissue itself. The symptoms of nausea, vomiting, diarrhea, fever, and metallic taste in Mr. J.R.’s case may suggest intrinsic AKI due to acute tubular necrosis (ATN) caused by toxins or ischemia. The ingestion of possibly contaminated food leading to gastroenteritis could introduce toxins that directly damage renal tubules, resulting in intrinsic AKI.
    • Postrenal AKI: This type occurs due to obstruction of urine flow from the kidneys. However, there are no symptoms suggestive of urinary obstruction in Mr. J.R.’s case, so postrenal AKI is less likely.
  2. Risk Factors for AKI:

    Several risk factors might contribute to Mr. J.R.’s development of AKI:

    • Advanced age: Mr. J.R. is 73 years old, which increases his susceptibility to renal injury due to age-related changes in renal function.
    • Dehydration: The history of nausea, vomiting, diarrhea, and fever suggests fluid loss, potentially leading to hypovolemia and decreased renal perfusion.
    • Medication use: The ingestion of Pepto-Bismol could contribute to renal injury, especially if Mr. J.R. has underlying renal impairment or if the medication interacts with other drugs he may be taking.
    • Possible toxin exposure: Consumption of contaminated food from a fast-food restaurant could introduce toxins that directly damage renal tissue.
  3. Complications of Chronic Kidney Disease (CKD) on Hematologic System:

    Hematologic complications commonly associated with CKD include coagulopathy and anemia:

    • Coagulopathy: CKD can lead to platelet dysfunction, impaired coagulation factor synthesis, and vascular endothelial dysfunction, predisposing patients to bleeding disorders and increased risk of thrombotic events.
    • Anemia: CKD-related anemia results primarily from decreased erythropoietin production by dysfunctional kidneys, leading to reduced red blood cell production and consequent anemia. Additionally, CKD can cause iron deficiency due to impaired iron metabolism and increased blood loss from gastrointestinal bleeding associated with uremia.

    The pathophysiologic mechanisms involved in these complications include dysregulation of hormonal pathways, inflammation, oxidative stress, and alterations in erythropoiesis and iron metabolism due to impaired renal function in CKD.

Case Study 2: Reproductive Function

  1. Probable Diagnosis for Ms. P.C.:

    Based on the clinical manifestations and microscopic examination findings, the most likely diagnosis for Ms. P.C. is pelvic inflammatory disease (PID). The symptoms of lower abdominal pain, nausea, emesis, and malodorous vaginal discharge, along with the presence of white blood cells and gram-negative intracellular diplococci on microscopic examination, are consistent with PID. The absence of yeast or flagellated microbes rules out vaginal candidiasis and trichomoniasis, respectively.

    PID is typically caused by ascending infection from the lower genital tract, often due to sexually transmitted pathogens such as Neisseria gonorrhoeae or Chlamydia trachomatis. The greenish-yellow discharge and presence of gram-negative intracellular diplococci further suggest infection with N. gonorrhoeae, a common causative agent of PID.

  2. Microorganism Involved:

    The presence of gram-negative intracellular diplococci in the vaginal discharge sample strongly suggests the involvement of Neisseria gonorrhoeae. This bacterium is a known causative agent of PID and is transmitted through unprotected sexual intercourse. N. gonorrhoeae typically infects the cervix and can ascend to the upper reproductive tract, leading to PID.

  3. Criteria for Hospitalization Recommendation:

    Hospitalization may be warranted for Ms. P.C. based on the following criteria:

    • Severity of symptoms: The presence of severe lower abdominal pain, nausea, vomiting, and malodorous vaginal discharge indicates a potentially serious infection requiring close monitoring and intravenous antibiotics.
    • Complications or risk of complications: PID can lead to serious complications such as tubo-ovarian abscess, pelvic peritonitis, or septic shock, especially if left untreated. Hospitalization allows for prompt evaluation and management of complications.
    • Need for intravenous antibiotics: Severe cases of PID may require intravenous antibiotic therapy to achieve adequate tissue penetration and ensure effective treatment.
    • Patient factors: Ms. P.C.’s young age and lack of previous genitourinary infections or sexually transmitted diseases may necessitate hospitalization for comprehensive evaluation and treatment, especially if outpatient management is not feasible or safe.

In conclusion, the presented case studies highlight the importance of thorough clinical evaluation, including history-taking, physical examination, and diagnostic testing, to accurately diagnose and manage urinary and reproductive system disorders. Early recognition and intervention are essential to prevent complications and improve patient outcomes.

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