Case Study 3 & 4:  Inflammatory Bowel Disease and Urinary Ob

Case Study 3 & 4:  Inflammatory Bowel Disease and Urinary Obstruction.  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). Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words.  The answers must be in your own words with reference to journal or book where you found the evidence to your answer. Do not copy paste or use a past students work as all files submited in this course are registered and saved in turn it in program. All answers to case studies must have reference cited in text for each answer and minimum of 2 Scholarly References (Journals, books) (No websites)  per case Study 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 Results Hemoglobin (Hgb), 8.6 g/dL (normal: >12 g/dL) Hematocrit (Hct), 28% (normal: 31%-43%) Vitamin B12 level, 68 pg/mL (normal: 100-700 pg/mL) Meckel scan, No evidence of Meckel diverticulum D-Xylose absorption, 60 min: 8 mg/dL (normal: >15-20 mg/dL)  120 min: 6 mg/dL (normal: >20 mg/dL)  Lactose tolerance, No change in glucose level (normal: >20 mg/dL rise in glucose) Small bowel series, 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 study 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 Results Routine laboratory studies Within normal limits (WNL) Intravenous pyelogram (IVP) Mild indentation of the interior aspect of the bladder, indicating an enlarged prostate Uroflowmetry with total voided flow of 225 mL 8 mL/sec (normal: >12 mL/sec) Cystometry Resting bladder pressure: 35 cm H2O (normal: <40 cm h2o) peak bladder pressure: 50 h2o (normal: 40-90 electromyography of the pelvic sphincter muscle normal resting with a positive tonus limb cystoscopy benign prostatic hypertrophy (bph) acid phosphatase (pap) 0.5 units l 0.11-0.60 l) prostate specificantigen (psa) 1.0 ngml <4 ml) ultrasound diffusely enlarged prostate;no localized tumor  diagnosticanalysis  because patient’s symptoms, outlet obstruction was highly suspected. physical examination indicated an prostate. ivp studies corroborated that finding. reduced urine flow rate distal to urinary bladder. patient found have total voided volume, one could not say result inadequately distended rather, appropriately distended, yet decreased. this obstruction. cystogram capable mounting effective pressure and atonic compatible neurologic disease. again able contract. normal, indicating appropriate muscular function based on these studies, diagnosed pap psa (bph). supported diagnosis. documented finding, treated by transurethral resection (turp). did well postoperatively had major problems.  critical thinking questions  1. does bph predispose cancer?  2. why are patients at increased risk for tract infections?  3. what would you expect level be after surgery?  4. is recommended screening guidelines treatment bph?  5. some alternative treatments >

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