scenario 4: A 65-year-old obese African American male patient presents to his HCP with crampy left lower quadrant pain, constipation, and fevers to 101Ëš F
Module 1 Assignment: Case Study Analysis
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Module 1 Assignment: Case Study Analysis
The provided case study demonstrates an obese 65-year-old male patient with chief complaints of crampy left lower quadrant pain, fever, and constipation. The patient reports a history of diverticulitis (chronic inflammatory bowel disease) which might have contributed to his current symptoms. He also confirms taking an unbalanced diet low in fiber and adopting a sedentary lifestyle with no physical exercise. His father also passed away from colon cancer. He agreed to a colonoscopy, which revealed multiple polyps positive for colon adenocarcinoma. The purpose of this discussion is to demonstrate the pathophysiology behind the patient presenting symptoms and the role of genetics and his immune system in the disease development process.
Pathophysiology
The patient complains of crampy left lower quadrant pain, fever, and constipation in addition to being obese. He also reports a history of diverticulitis (chronic inflammatory bowel disease), which might have contributed to these symptoms, in addition to his low fiber unbalanced diet, and sedentary lifestyle. Studies show that small pouches normally bulge from the inner lining of the lower digestive tract of patients with diverticulitis (Kayano et al., 2019). Tearing one or several of these pouches normally causes inflammation, which may result from infections in some instances, presenting in the form of fever, lower abdominal pain, constipation, and nausea (Koo et al., 2020). Additionally, a high-fiber diet usually helps increase the bulk of feces. As such, the patient consuming a low fiber diet worsens constipation. Additional contributing factors to the patient’s condition include a sedentary lifestyle, advanced age, and obesity.
Genetics
Colon cancer is normally associated with several complex health complications in relation to genetic alterations which promote the progression of an adenoma to invasive adenocarcinoma. Colon cancer is considered one of the most common cancer syndromes that are inherited. Studies show that in the early stages, mutations of the adenomatous polyposis gene (APG) usually occur as an inheritable gene from patients with familial adenomatous polyposis (FAP) (Hassab et al., 2020). Additional genes involved in the development of cancer of the colon include the KRAS proto-oncogenes and Deleted in Colorectal Carcinoma (DCC) tumor suppression genes.
Immunosuppression
Immunosuppression is described as the dysfunction of the immune response of an individual either temporarily or permanently because of any kind of disruptions to the immune system functioning, predisposing the individual to infections among other health complications (McKechnie et al., 2021). Several factors have been associated with the cause of immunosuppression such as drugs like corticosteroids, and chronic health conditions like chronic inflammatory bowel disease (diverticulitis). Researchers have also reported that tumor cells normally release immunosuppressive factors that have both local and system effects on the functioning of the patient’s immune system (Kearney et al., 2021). The immunosuppressive factors which are normally produced by tumor cells include but are not limited to adenosine, Interleukin-10 (IL-10), PGE2, and Transforming Growth Factor-β (TGF-β). They are responsible for impairment of the immune cell function. Hence the patient’s body system is unable to defend itself against foreign bodies like microorganisms which increase the risks of infection among other health complications.
Conclusion
The patient in the provided case study is obese, with symptoms that suggest adenocarcinoma of the colon. The patient’s condition might have been contributed by diverticulitis, advanced age, and a family history of colon cancer. Several genetic factors including APG, KRAS proto-oncogenes, and DCC tumor suppression genes are normally involved in the development of colon cancer. Studies also show that tumor cells can also produce immunosuppressive factors which increase the patient’s risk of infection. With this understanding, it is necessary to manage the underlying causes of the patient’s condition and promote a healthy lifestyle for a better outcome.
References
Hassab, T., D’Adamo, C. R., Patel, S. D., Mavanur, A. A., Svoboda, S., & Wolf, J. H. (2020). Risk of Unexpected Colon Cancer after Operation for Suspected Diverticulitis. Journal of the American College of Surgeons, 231(4), e11-e12. DOI: 10.1016/j.jamcollsurg.2020.08.030
Kayano, H., Ueda, Y., Machida, T., Hiraiwa, S., Zakoji, H., Tajiri, T., … & Nomura, E. (2019). Colon cancer arising from colonic diverticulum: A case report. World Journal of Clinical Cases, 7(13), 1643. PMID: 31367623
Kearney, M. B., Williams, J. M., & Ebell, M. H. (2021). Colon Cancer and Diverticular Disease Association: a Case-Control Study. Journal of Gastrointestinal Cancer, 52(1), 120-124. https://doi.org/10.1007/s12029-019-00355-1
Koo, C. H., Chang, J. H., Syn, N. L., Wee, I. J., & Mathew, R. (2020). Systematic review and meta-analysis on colorectal cancer findings on colonic evaluation after CT-confirmed acute diverticulitis. Diseases of the Colon & Rectum, 63(5), 701-709. https://doi.org/10.1097/DCR.0000000000001664
McKechnie, T., Lee, Y., Kruse, C., Qiu, Y., Springer, J. E., Doumouras, A. G., … & Eskicioglu, C. (2021). Operative management of colonic diverticular disease in the setting of immunosuppression: A systematic review and meta-analysis. The American Journal of Surgery, 221(1), 72-85. https://doi.org/10.1016/j.amjsurg.2020.06.035