Review of a Pathological Condition - Essay Example

?REVIEW OF A PATHOLOGICAL CONDITION Introduction A pathological condition manifested by any abnormal anatomical or physiological conditions that imply the presence of disease according to the objectivity or subjectivity of a medical practitioner (William and Christine, 2005). Healthcare providers have indicated that a pathological condition of a part, organ or system of an organism results from various causes and is characterised by an identifiable group of symptoms (William and Christine, 2005). Based on this definition, several pathological conditions can be identified from the case presented in the scenario of a diabetic (undefined) male, aged 34, featuring fatigue, pruritus, oliguria and insufficiency fractures. In this case, the most probable cause for these symptoms could be uncontrolled diabetes mellitus or/and other long standing endocrine disorders therefore co-morbidities, leading to complications or death due to not being treated appropriately. The review of these pathological conditions, are presented by discussing categories of common causes of symptoms and disease progression, most susceptible individuals, utilising diagnostic imaging procedures for treatment and prognosis. Causes of the symptoms Genetics, environmental factors, poor diet, obesity, medications, infections and sedentary lifestyle have been cited by Chapman and Nakielny (2009) and William and Christine (2005) as some of the possible causes of diabetes as indicated in Richard and Neil (2007). Diabetics require strict dietary control to minimise the impact on lifestyle, as observed by Launer (2009) as the body fails to produce or utilise insulin properly. The islets of Langerhans of the pancreas contain four types of cells, but two cells, alpha cells producing glucagon, which opposes insulin and beta cells responsible for producing insulin (Scobie, 2007). In Type 1 diabetes, there is a lack of insulin with only glucagon present inducing hyperglycemia. With the absence of insulin to absorb glucose in the bloodstream to metabolise complex sugars, glucose levels in the body increases leading to uncontrolled diabetes with hyperglycemia affecting the kidneys. The abnormal structural condition of this individual with a plethora of signs and symptoms, i.e., diabetes, fatigue, an insufficiency fracture of the femoral neck, oliguria and pruritus, all indicating uncontrolled diabetes leading to renal failure attributing to calcium/mineral abnormalities and toxicity in the body. Parathyroid disorders may also exacerbate the condition if this is present or initiated through renal failure. Disease Progression Diabetes is a group of metabolic diseases with characteristic hyperglycemia associated with defects in insulin secretion, insulin action, or both (Launer, 2009). Type 1 diabetes is characterized by beta cell destruction, usually leading to absolute insulin deficiency. Type 2 diabetes on the other hand presents as a spectrum of metabolic abnormalities with prominent insulin resistance and relative insulin deficiency (William and Christine, 2005). The effect of diabetes is not limited to carbohydrate metabolism, but lipid and protein metabolism play an important role in its progression as noted by Launer (2009). Diabetic progression is initiated through numerous metabolic events that occur over a period of years. Repeated hyperglycemic attacks or chronic hyperglycemia, results in damage to other organs such as the kidneys leading to other complications or death. Hyperglycemia affects the kidneys causing diabetic nephropathy and glomerular filtration reduction. This result in the following manifestations: uncontrolled diabetes causing renal failure, resulting in oliguria, pruritus, fatigue and insufficiency fractures. It is a chain effect. Controlling metabolic events make it possible to slow or stop the progression of the disease. There are three main types of diabetes. The symptoms are similar although there are differences in the way they develop. In Type 1 diabetes, the signs and symptoms are usually very obvious and can develop quickly (Launer, 2009). The underlying indicator for Type 1 diabetes is the presence of acid compounds in the blood, a condition referred to as ketoacidosis (Scobie, 2007). Type 2 diabetes is insidious and individuals do not recognise that they are ill. This type is widespread in people aged over 40 years, particularly if they are obese, but also occurs in younger people/children. Progression to renal failure and subsequent manifestations Diabetes can result in kidney disease which has 5 stages and is usually discovered at stage 3, with the last stage being kidney failure (Harris et al, 2006). The average person with diabetes takes 20 years approximately to progress to the end stage (Harris et al, 2006). Type 1 and 2 diabetes can lead to kidney disease. Type 1 is more likely to lead to end-stage renal failure when the GRF of the kidneys has almost ceased. Diabetic nephropathy destroys glomerular tissue due to hyperglycaemia; causing glomerulonephritis with reduced GFR, associated with oliguria (Boon et al, 2006). The presentation of these symptoms, all-emanating from diabetes has the indication of stage 5 in renal failure. Retention of potassium and excretion of calcium required for interaction with vitamin D, both necessary for skeletal integrity, results in secondary hyperparathyroidism, excessive parathyroid hormone (PTH) to restore calcium levels (Boon et al, 2006), which is taken from bones. This leads to reduced bone mineral density, leading to fractures. A build up of toxins in the blood through kidneys failing contributes to pruritus, fatigue/lethargy in addition to excessive PTH and hyperglycaemia. The tissues/structures involved Organs of the chest and abdomen including the heart, liver, biliary tract, kidneys, spleen, bowel, pancreas and adrenal glands have been indicated as commonly affected by the pathological condition presented in the scenario. Occasionally, pelvic organs including the reproductive organs in the male and the female as well as blood vessels and breasts are involved. Epidemiology The prevalence of diabetes in persons aged 45 to 64 years is about 7% but the proportion increases significantly in persons who are aged 65 years or above (Launer, 2009). Certain minority populations have even higher rates as attested by extant literature. Despite its high prevalence, diabetes is largely under-diagnosed as indicated by Florence and Bryan (2011). It is estimated that over 8 million people in the United Kingdom alone are unaware that they have the disease (Eziama, 2009). Patients with undiagnosed diabetes are at serious risk of coronary heart disease, stroke and peripheral vascular disease and have a greater likelihood of dyslipidemia, hypertension and obesity (Chapman and Nakielny, 2009). Moreover, people belonging to certain ethnic groups such as Black, Hispanic, Native American, Asian American and Pacific Islander are at an increased risk of succumbing to uncontrolled diabetes (Eziama, 2009). Imaging of diabetic complications URINARY – CT, ULTRSOUND, A renal ultrasound is typically obtained to observe for kidney size. In the early stages of diabetic nephropathy, kidney size may be enlarged from hyperfiltration. With progressive kidney disease through diabetes, the kidneys diminish in size from glomerulosclerosis. In addition, a renal ultrasound can assess for hyperechogenicity that suggests chronic kidney disease and can assist in ruling out obstruction. SKELETAL – CT, MRI, PLAIN XRAY (INITIAL), RNI, A skeletal CT scan on the one hand is done to identify any bone lesions that may be present in the skeleton. The scan may yield additional diagnostic information for very small lesions or in cases that have confusing radiographic findings (Albert, 2008). Both osteosarcoma and Ewing sarcoma metastasize to the lungs. To forestall this escalation, it is advisable that bone lesions should be biopsied in a center that has experience in the diagnosis and management of bone tumors. MRI of the local site of a bone lesion should be performed before any biopsy (Albert, 2008) as indicated in the chart below showing MRI of the knee. Source: Albert, B. L (2008) ENDOCRINE – PANCEAS, PARATHYROID – CT, ULTRASOUND, RNI, Research indicate that MRI scans are extremely valuable (when positive) for localizing a parathyroid adenoma although the sestamibi has decreased the need for it dramatically. But all in all, an ultrasound may be performed since it is inexpensive, easily performed, carries no significant risks, and can occasionally be useful in localizing a parathyroid adenoma (Albert, 2008). In fact, ultrasound is considered to be very accurate when used to examine the thyroid as illustrated in the chart below. Source: Albert, B. L (2008) The advantages of specific imaging techniques Imaging is able to reveal subtle change that is indicative of the progression of therapy that may be missed out by more subjective, traditional approaches. Statistical bias is reduced as the findings are evaluated without any direct patient contact (Albert, 2008). Particularly when using MR images of the soft-tissue structures of the body such as the heart, liver and many other organs, imaging has proven valuable in diagnosing a broad range of conditions, including cancer, heart and vascular disease, and muscular and bone abnormalities. Treatment and Prognosis of Uncontrolled Diabetes All treatment strategies should lay emphasis on cardiovascular risk reduction, focusing particularly on hypertension control, smoking cessation and correction of dyslipidemia (Florence and Bryan, 2011). Diet, exercise and weight reduction should be the cornerstone of management as advised by Sigal et al (2007). If the current approach to management of drug therapy in patients with Type 2 diabetes fails to provide adequate glycemic control, it becomes important to begin insulin therapy (Florence and Bryan, 2011). Eziama (2009) further advises that 50 units of soluble insulin should be given intramuscularly every half hour in severe uncontrolled diabetes cases until there is a marked fall of the blood glucose level to below 300 milligram percent. Attaining this level indicates that both glucose and potassium are passing into the cells and that carbohydrates are being metabolised (Sigal et al, 2007). Insulin will continue to be required for normal metabolism after the crisis has passed (Eziama, 2009). Daily home glucose monitoring for diabetes is necessary for patients undergoing therapy with insulin or oral agents. Patients with uncontrolled diabetes requiring medication adjustment need more intensive monitoring according to Sigal et al (2007). The frequency and timing of glucose monitoring should be individualised for each patient. Monitoring should occur regularly to facilitate reaching treatment goals (Florence and Bryan, 2011). Additionally, calcium and vitamin D supplements will be required to reverse the effects of uncontrolled diabetes on the skeletal system. Conclusion People with long-term diabetes especially, are likely to experience CKD and suffer with co-morbid illnesses such as bone disease, anemia and cardiovascular complications. In reference to the 34 years old patient presented in the scenario, common symptoms of uncontrolled diabetes manifest. There is observed sudden weight loss, blurred vision, fatigue, itchy skin, an insufficiency fracture of the femoral neck and oliguria. These signs are all reminiscent of what has been discoursed throughout the essay. Additionally, uncontrolled diabetes is known to affect people who are usually over the age of 40. However, people of South Asian and African-Caribbean descent can develop the disease after the age of 25 (Chapman and Nakielny, 2009). Children too, are diagnosed with diabetes. Older pregnant women are more prone to the condition (Launer, 2009), because the body has less ability to produce enough insulin to meet the extra demands of pregnancy. In most of the cases, treatment of uncontrolled diabetes is by insulin therapy supplemented by close glucose monitoring of each patient. Bibliography Burkhard, G. (2010) What are the Potential Benefits of Clinical ?-Cell Imaging in Diabetes Mellitus? Bentham Science Publishers, Volume 16, Number 14, pp. 1547-1549(3). Chapman and Nakielny. (2009) Aids to Radiological Differential Diagnosis 5th Edition, Saunders Elsevier. Eziama, C. (2009) Treating Uncontrolled Diabetes. Retrieved May 5, 2011, from http://ezinearticles.com/?Treating--Uncontrolled--Diabetes&id=2873625. Florence, J. A. and Bryan, F. Y. (2011). The American Family Physician, The American Academy of Family Physicians, pp. 14-17. Launer, L. J. (2009) Diabetes: Vascular or neurodegenerative? An epidemiologic perspective. Stroke; 40: S53. Richard, I. G., and Neil, A. H. (2007) Essential Endocrinology and Diabetes 5th Edition, Blackwell Publishing, Oxford. Scobie, I. (2007) Atlas of Diabetes Mellitus. 3rd Edition, Informa Healthcare, Oxon. Sigal, R. J, et al. (2007) Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes. Annals of Internal Medicine, 147: 357. William, A and Christine, A. (2005) The Encyclopedia of Endocrine Diseases and Disorders, Facts on file, Inc., New York. Albert, B. L (2008) Encyclopedia of Diagnostic Imaging. Berlin: Springer-Verlag. Harris, D et al. (2006) Prevention of progression of kidney disease. Westmead NSW (Australia): CARI Read More