Scenario 2: A 24-year-old Female with a Complaint of Severe Right-sided Headache
Scenario 2: Patient is a 24-year-old female administrative assistant who comes to the emergency department with a chief complaint of severe right-sided headache. She states that this is the sixth time in the last 2 months she has had this headache. She says the headaches last 2–3 days and have impacted her ability to concentrate at work. She complains of nausea and has vomited three times in the last 3 hours. She states, “the light hurts my eyes.” She rates her pain as a 10/10 at this time. Ibuprofen and acetaminophen ease her symptoms somewhat but do not totally relieve them. No other current complaints.
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.
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.
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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