Module 5 Assignment: Case Study Analysis
The 65-year-old male patient in the assigned case study is obese and presents to the clinic complaining of constipation, fever, and crampy left lower quadrant pain. The patient has a history of chronic inflammatory bowel disease (diverticulitis), an unbalanced diet with inadequate fiber, and a sedentary lifestyle. He also has a family history of colon cancer, which led to his father’s death. Upon performing colonoscopy, multiple polyps were noted, which revealed positive results for adenocarcinoma of the colon. This discussion illustrates the pathophysiology behind the patient’s symptoms and the role of genetics and the immune system in developing the disease.
Pathophysiology Behind the Patients Symptoms
The patient’s chief complaints are fever, constipation, and crampy left lower quadrant pain. These symptoms are associated with the patient’s history of chronic inflammatory bowel disease (diverticulitis), sedentary lifestyles, and inadequate consumption of fibers. In diverticulitis, small bulging pouches form in the inner lining of the lower digestive system. When one or several of these pouches tear, leading to inflammation, and in some instances, infections, the patient presents with lower abdominal pain, fever, nausea, and marked changes in bowel behavior such as chronic constipation. Fibers are also known to increase the bulk of feces (Kayano et al., 2019). As such, consuming a diet that lacks fiber and adopting a sedentary life reduces bowel movement, worsening the patient’s constipation.
Cancer of the colon is usually associated with complex health complications and genetic alterations promoting progression from adenoma to invasive adenocarcinoma. The early stages are associated with mutations of the adenomatous polyposis gene (APG), which was initially discovered as an inheritable gene from a patient with familial adenomatous polyposis (FAP) (Otani et al., 2019). Other significant genes associated with the development of colon cancer are the KRAS oncogene and deleted in colon cancer (DCC) tumor suppression genes.
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The process of immunosuppression can be defined as a permanent or temporary dysfunction of the body’s immune response due to disruption of the immune system, hence leading to increased susceptibility to infections, among other diseases. Immunosuppression may be caused by certain medications which are known to suppress the immune system or chronic conditions such as chronic inflammatory bowel disease (diverticulitis). Studies also show that tumor cells release immunosuppressive factors, which have both systemic and local effects on immune function. Such immunosuppressive factors produced by tumor cells include; Transforming Growth Factor-β (TGF-β), PGE2, adenosine, and Interleukin-10 (IL-10), which impairs the functions of immune cells (Otani et al., 2019). As s result, the body system fails to defend itself against disease making it more vulnerable to infections, among other pathological factors.
The case study provided demonstrates a patient with adenocarcinoma of the colon. The patient’s medical and family history support this diagnosis. The pathophysiology of this condition is associated with several genetic factors such as adenomatous polyposis gene (APG), KRAS oncogene, and deleted in colon cancer (DCC) tumor suppression genes. Studies also show that tumor cells usually produce immunosuppressive factors responsible for diminishing the immune system of cancer patients. They are thus more vulnerable to infections, among other diseases.
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. DOI: 10.12998/wjcc.v7.i13.1643
Otani, K., Kawai, K., Hata, K., Tanaka, T., Nishikawa, T., Sasaki, K., … & Nozawa, H. (2019). Colon cancer with perforation. Surgery today, 49(1), 15-20. https://doi.org/10.1007/s00595-018-1661-8
The patient developed the symptoms because of the possible side effects of the transplant procedure and the medications administered. It may be impossible for healthcare providers to eliminate all the adverse drug interactions in the patients. The current assignment explains the symptoms evident in the patient’s case and the genes linked with the development of the disease. Also, the paper explains the process of immunosuppression and its effect on the body.
In this, the response to the medication and medical procedure depends on many factors including genetic composition, and could trigger the symptoms. The postoperative procedure was uneventful and the patient was discharged and given anti-rejection drugs as illustrated in the case. There is the possibility that the patient developed transplant rejection leading to renal failure that contributed to the weight gain and the reduced urine output (Kuan & Schwartz, 2021). Furthermore, the sensitization of the body to the foreign organ contributed to the rising of temperate and feeling fatigued.
The genes that contributes to the development renal disease include rs25487 of the XRCC1. The gene makes people vulnerable to end-stage renal disease. Furthermore, the GSTP1 gene is also linked to the C-reactive protein and the ferritin levels. According to Abd EL-Hassib et al. (2021), individuals with the gene have increased risks for oxidative and carbonyl stress. Patients with end-stage renal disease have increased levels of C-reactive proteins which are indicators of increased inflammation. Furthermore, they demonstrate a high oxidative stress level.
Immunosuppression reduces the ability of the body to activate the immune response to the pathogens (Benvenuto et al., 2018). The process may be achieved through the reduction in the number of T-helper cells which recognizes the foreign objects and activate other immune cells to fight the pathogen (Tielemans et al., 2019). Alternatively, the effect may also be induced in the bone marrow. Besides, it reduces the inflammation in the body and the associated symptoms. However, it could be detrimental to the body because of the increased susceptibility to infections (Brown et al., 2017).
Finally, the human system is interconnected, and thus when one organ has been affected the rest may also suffer. In this case, the patient suffered organ transplant rejection and this could lead to increased inflammation. Decreased urine output was an indication of renal failure.
Abd EL-Hassib, D. M., Zidan, M. A., El Amawy, M. M., Hegazy, H. A., & Ameen, S. G. (2021). Polymorphism of XRCC1 Arg399Gln may predict for development of end-stage renal disease. A PCR confirmed case-control study. Meta Gene, 29, 100915. https://doi.org/10.1016/j.mgene.2021.100915
Benvenuto, L. J., Anderson, M. R., & Arcasoy, S. M. (2018). New frontiers in immunosuppression. Journal of Thoracic Disease, 10(5), 3141-3155. https://doi.org/10.21037/jtd.2018.04.79
Brown, S. A., Tyrer, F. C., Clarke, A. L., Lloyd-Davies, L. H., Stein, A. G., Tarrant, C., Burton, J. O., & Smith, A. C. (2017). Symptom burden in patients with chronic kidney disease not requiring renal replacement therapy. Clinical Kidney Journal, 10(6), 788-796. https://doi.org/10.1093/ckj/sfx057
Kuan, K., & Schwartz, D. (2021). Educational case: Kidney transplant rejection. Academic Pathology, 8, 237428952110068. https://doi.org/10.1177/23742895211006832
Tielemans, M. M., Van Boekel, G. A., Van Gelder, T., Tjwa, E. T., & Hilbrands, L. B. (2019). Immunosuppressive drugs and the gastrointestinal tract in renal transplant patients. Transplantation Reviews, 33(2), 55-63. https://doi.org/10.1016/j.trre.2018.11.001