Case Study 1: Disorders of Hepatobiliary and Exocrine Pancreas FunctionRobert is a 68-year-old who has dealt with alcoholism for over 30 years. He has cirrhosis and is anemic. His appetite has declined, and he regularly complains of abdominal pain. Recently, while preparing himself a sandwich, he cut his finger deeply with a knife. The wound bled profusely, and he used a kitchen towel to stop the flow. Refusing to go and seek medical assistance, he put ice on his finger and wrapped the towel around it. He sat down in his recliner with his hand over his head and fell asleep.
- Anemia and clotting disorders are common features of alcoholic liver disease. What are the mechanisms that cause these hematologic disorders?
- What gastrointestinal bleed is associated with a high mortality rate in those with advanced cirrhosis? What is the pathophysiology of this condition?
- Acute pancreatitis is sometimes seen in alcoholics, particularly after binge drinking. Why are tachycardia and hypotension indications of this condition?
- Why are women more predisposed to alcoholic liver disease than men?
Case Study 2: Somatosensory Function, Pain, Headache, and Temperature Regulation
Ramandeep is an active 23-year-old. She works as a part-time nurse during the day and is studying for a postgraduate certificate in the evening. Ramandeep started to wear a bite plate at night after she began to experience jaw pain and headaches. Sometimes the pain radiated to her ear, and she would apply a hot water bottle to it to ease the discomfort. It was not until her husband mentioned to her that he heard her grinding her teeth at night while she was sleeping. She knew then that her headaches might be from temporomandibular joint syndrome, and she went to her dentist to confirm her thoughts. In addition to the bite plate, the dentist also recommended she should continue with the application of heat, use NSAIDs when needed, and incorporate regular relaxation exercises throughout her stressful days.
- What effect does heat have on nociceptors so that it makes a good nonpharmacologic treatment for pain?
- Heat and cold treatment are both hypothesized to have an effect on the release of endogenous opioids. What are these chemicals, and why are they hypothesized to be beneficial in the body?
- Using your knowledge of physiology, how do NSAID analgesics function in the management of pain?
Case Study 3: Disorders of Visual Function
Phil is a 54-year-old with type 2 diabetes. After he was initially diagnosed with the condition, his physician referred him to an ophthalmologist for a comprehensive eye examination. Phil had been struggling with the lifestyle changes he was required to make. He was able to return to a healthy weight with physical exercise and dietary changes, but he worked long hours and ate poorly when on business trips. Phil missed his second annual checkup with his ophthalmologist because of such a trip. When he finally made it in, she examined him and stated there was no evidence of small retinal hemorrhages and cotton-wool exudates. She emphasized his need to reduce his hypertension and hyperlipidemia and wrote up a report for his physician.
- How do visual disturbances arise from background and proliferative retinopathy?
- How might blindness occur with a prolonged detached retina? Explain using your knowledge of pathophysiology.
- What are the similarities and differences between traction retinal detachment and rhegmatogenous detachment?
Case Study 4: Mechanisms of Endocrine Control
Leda is a 38-year-old woman who began to experience weight gain, mood swings, and weakness. When her periods became irregular, she went to her physician. Leda’s physician heard the symptoms Leda was concerned about and then ordered a 24-hour free cortisol urine test and an overnight dexamethasone suppression test and measured her serum ACTH levels. The results indicated that Leda had Cushing disease, a condition caused by the hypersecretion of ACTH by the anterior pituitary and resulting in elevated cortisol levels. To confirm the diagnosis, Leda’s physician ordered a cranial MRI to identify the presence of a pituitary tumor.
- The dexamethasone test involves the administration of a synthetic glucocorticoid (e., cortisol). Knowing what you do about negative feedback mechanisms, how might this test be used to assess pituitary function?
- Describe how the steroid hormones, like cortisol, are metabolized in the body. What are the advantages of using a 24-hour urine test to measure this hormone?
- Protein-based and steroid-based hormones trigger cellular responses in different ways. What are the differences between the mechanism of action of ACTH and cortisol on target cells?
Case Study 5: Disorders of Endocrine Control of Growth and Metabolism
Bertha is a 71-year-old woman who takes daily medication for Hashimoto thyroiditis. Last winter, she developed pneumonia. Although she did her best to run errands for her husband, she became tired easily and needed to rest frequently. One day, after shoveling the snow outside, her husband came inside to find Bertha lying on the sofa covered in blankets. Her face appeared puffy and her eyelids hung. When he spoke to her, Bertha’s voice was hoarse and her words did not make sense to him. Her respirations were also shallow and slow. Suspecting low thyroid hormone levels were causing the signs, her husband called for an ambulance.
- When testing for hypothyroidism, why is the free T4 level an important measurement? What would the TSH and T4 test results indicate in someone with primary hypothyroidism?
- Using your knowledge of the function of thyroid hormone in the body, explain why Bertha’s respiratory rate was decreased? Why might pleural effusion be present in someone with hypothyroidism?
- What factors in Bertha’s history leave her susceptible to myxedematous coma? What are the physiologic aspects involved in myxedematous coma?
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